hospital_name last_updated_on version hospital_location hospital_address license_number|CA "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements Of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." Northern Inyo Hospital 10/1/2024 2.2.0 Northern Inyo Hospital "150 Pioneer Lane, Bishop, CA 93514" 240000179 TRUE description code|1 code|1|type code|2 code|2|type code|3 code|3|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge|gross standard_charge|discounted_cash payer_name plan_name standard_charge|negotiated_dollar standard_charge|negotiated_percentage standard_charge|negotiated_algorithm estimated_amount standard_charge|methodology standard_charge|min standard_charge|max additional_generic_notes "Naltrexone, depot form" 759 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 339.43 other 339.43 339.43 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits 5022 APC facility outpatient Blue Shield Anthem 89.4 491.9 percent of total billed charges 491.9 595.84 Level 2 Type A ED Visits 5022 APC facility outpatient United Healthcare All Commercial Plans 98 595.84 percent of total billed charges 491.9 595.84 Level 3 Type A ED Visits 5023 APC facility outpatient Blue Cross Anthem 99 886.73 percent of total billed charges 886.73 2092.64 Level 3 Type A ED Visits 5023 APC facility outpatient Blue Shield Anthem 89.4 1855.42 percent of total billed charges 886.73 2092.64 Level 3 Type A ED Visits 5023 APC facility outpatient Cigna All Commercial Plans 98.5 2092.64 percent of total billed charges 886.73 2092.64 Level 3 Type A ED Visits 5023 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 1181.96 other 886.73 2092.64 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits 5024 APC facility outpatient Blue Cross Anthem 99 2591.04 percent of total billed charges 2591.04 5305.88 Level 4 Type A ED Visits 5024 APC facility outpatient Blue Shield Anthem 89.4 4073.08 percent of total billed charges 2591.04 5305.88 Level 4 Type A ED Visits 5024 APC facility outpatient Cigna All Commercial Plans 98.5 5305.88 percent of total billed charges 2591.04 5305.88 Level 4 Type A ED Visits 5024 APC facility outpatient Hometown Health Hmo/Ppo 99 3529.32 percent of total billed charges 2591.04 5305.88 Level 4 Type A ED Visits 5024 APC facility outpatient United Healthcare All Commercial Plans 98 2851.8 percent of total billed charges 2591.04 5305.88 Level 4 Type A ED Visits 5024 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 3231.76 other 2591.04 5305.88 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits 5025 APC facility outpatient Blue Cross Anthem 99 1088.9 percent of total billed charges 300 7177.75 Level 5 Type A ED Visits 5025 APC facility outpatient Cigna All Commercial Plans 98.5 5118.9 percent of total billed charges 300 7177.75 Level 5 Type A ED Visits 5025 APC facility outpatient Health Net All Commercial Plans 99 300 percent of total billed charges 300 7177.75 Level 5 Type A ED Visits 5025 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 7177.75 other 300 7177.75 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures 5051 APC facility outpatient Blue Cross Anthem 99 858 percent of total billed charges 230.36 858 Level 1 Skin Procedures 5051 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 230.36 other 230.36 858 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures 5051 APC facility outpatient Cigna All Commercial Plans 98.5 553.17 percent of total billed charges 230.36 858 Level 2 Skin Procedures 5052 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 253.1 other 253.1 253.1 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Strapping and Cast Application 5101 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 241.59 other 241.59 241.59 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures 5112 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 3794.62 other 3794.62 3794.62 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures 5181 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 170.42 other 170.42 170.42 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures 5183 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 860.33 other 860.33 860.33 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures 5311 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 23.66 other 23.66 23.66 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures 5411 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 111.78 other 111.78 2560.5 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures 5411 APC facility outpatient Hometown Health Hmo/Ppo 99 2560.5 percent of total billed charges 111.78 2560.5 Level 1 Nerve Injections 5441 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 158.78 other 158.78 158.78 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections 5442 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 1005.99 other 1005.99 1005.99 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Intraocular Procedures 5491 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 1012.47 other 1012.47 1012.47 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast 5521 APC facility outpatient Bc Managed Care Medi-Cal Medicaid Managed Care Plan 84 18.14 percent of total billed charges 18.14 374.1 Level 1 Imaging without Contrast 5521 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 83.8 other 18.14 374.1 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast 5521 APC facility outpatient Cigna All Commercial Plans 98.5 374.1 percent of total billed charges 18.14 374.1 Level 1 Imaging without Contrast 5521 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 215.14 other 18.14 374.1 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast 5522 APC facility outpatient Blue Cross Anthem 99 63.05 percent of total billed charges 63.05 1093.62 Level 2 Imaging without Contrast 5522 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 92.63 other 63.05 1093.62 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast 5522 APC facility outpatient Cigna All Commercial Plans 98.5 483.02 percent of total billed charges 63.05 1093.62 Level 2 Imaging without Contrast 5522 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 1093.62 other 63.05 1093.62 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast 5523 APC facility outpatient Bc Managed Care Medi-Cal Medicaid Managed Care Plan 84 126.48 percent of total billed charges 126.48 11477.24 Level 3 Imaging without Contrast 5523 APC facility outpatient Blue Cross Anthem 99 3448.66 percent of total billed charges 126.48 11477.24 Level 3 Imaging without Contrast 5523 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 344.3 other 126.48 11477.24 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast 5523 APC facility outpatient Cigna All Commercial Plans 98.5 2898.13 percent of total billed charges 126.48 11477.24 Level 3 Imaging without Contrast 5523 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 11477.24 other 126.48 11477.24 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast 5524 APC facility outpatient Blue Cross Anthem 99 2419 percent of total billed charges 299.7 2419 Level 4 Imaging without Contrast 5524 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 299.7 other 299.7 2419 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast 5524 APC facility outpatient Geha All Commercial Plans 92 2370.62 percent of total billed charges 299.7 2419 Level 4 Imaging without Contrast 5524 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 1350.9 other 299.7 2419 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast 5571 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 208.61 other 208.61 208.61 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast 5572 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 440.15 other 440.15 440.15 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast 5573 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 312.36 other 312.36 312.36 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services 5591 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 9.44 other 9.44 1328.44 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services 5591 APC facility outpatient United Healthcare All Commercial Plans 98 1013.51 percent of total billed charges 9.44 1328.44 Level 1 Nuclear Medicine and Related Services 5591 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 1328.44 other 9.44 1328.44 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services 5593 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 510.03 other 510.03 4726.45 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services 5593 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 4726.45 other 510.03 4726.45 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology 5671 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 122.97 other 122.97 25310.3 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology 5671 APC facility outpatient Cigna All Commercial Plans 98.5 25310.3 percent of total billed charges 122.97 25310.3 Level 3 Pathology 5673 APC facility outpatient Blue Shield Anthem 89.4 20747.96 percent of total billed charges 371.26 20747.96 Level 3 Pathology 5673 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 371.26 other 371.26 20747.96 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Pathology 5674 APC facility outpatient Blue Cross Anthem 99 15691.13 percent of total billed charges 15691.13 15691.13 Level 1 Drug Administration 5691 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 1180.35 other 1180.35 1180.35 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration 5692 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 98.49 other 98.49 98.49 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration 5693 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 358.52 other 358.52 358.52 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services 5722 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 134.59 other 134.59 1190.54 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services 5722 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 1190.54 other 134.59 1190.54 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Minor Procedures 5731 APC facility outpatient Blue Cross Anthem 99 5.38 percent of total billed charges 5.38 5.38 Level 2 Minor Procedures 5732 APC facility outpatient Bc Managed Care Medi-Cal Medicaid Managed Care Plan 84 136 percent of total billed charges 14.03 136 Level 2 Minor Procedures 5732 APC facility outpatient Blue Cross Anthem 99 14.03 percent of total billed charges 14.03 136 Level 2 Minor Procedures 5732 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 43.87 other 14.03 136 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures 5733 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 116.75 other 116.75 145.32 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures 5733 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 145.32 other 116.75 145.32 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures 5734 APC facility outpatient Bc Managed Care Medi-Cal Medicaid Managed Care Plan 84 202.78 percent of total billed charges 75.15 2206.98 Level 4 Minor Procedures 5734 APC facility outpatient Blue Cross Anthem 99 2206.98 percent of total billed charges 75.15 2206.98 Level 4 Minor Procedures 5734 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 75.15 other 75.15 2206.98 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Rabies vaccine, im" 9139 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 866.02 other 866.02 866.02 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Buprenorphine xr over 100 mg 9239 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 2262.8 other 2262.8 2262.8 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services N800 APC facility outpatient Aetna All Commercial Plans 85 212.12 percent of total billed charges 13.15 489.64 Clinical Diagnostic Lab Services N800 APC facility outpatient Blue Cross Anthem 99 13.15 percent of total billed charges 13.15 489.64 Clinical Diagnostic Lab Services N800 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 61.35 other 13.15 489.64 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services N800 APC facility outpatient Cigna All Commercial Plans 98.5 489.64 percent of total billed charges 13.15 489.64 Clinical Diagnostic Lab Services N800 APC facility outpatient Geha All Commercial Plans 92 20.62 percent of total billed charges 13.15 489.64 Clinical Diagnostic Lab Services N800 APC facility outpatient United Healthcare All Commercial Plans 98 486.08 percent of total billed charges 13.15 489.64 Clinical Diagnostic Lab Services N800 APC facility outpatient United Healthcare Advantage Medicare Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 180.52 other 13.15 489.64 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services N801 APC facility outpatient Blue Shield Anthem 89.4 30 percent of total billed charges 30 121.4 Therapy Services N801 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 121.4 other 30 121.4 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services N804 APC facility outpatient Blue Cross Anthem 99 501.93 percent of total billed charges 138.41 501.93 Mammography Services N804 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 138.41 other 138.41 501.93 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services N804 APC facility outpatient United Healthcare All Commercial Plans 98 218.42 percent of total billed charges 138.41 501.93 Packaged Services N902 APC facility outpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 62 other 62 62 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Protein C-Functional LC #REF! CDM 305 RC facility both 9.49 9.49 Gross Charge Type: NIHD_Hosp_Profee_Price Protein C-Functional LC #REF! CDM 305 RC facility both 14.1 14.1 Gross Charge Type: NIHD_Hosp_Profee_Price 0141A IM ADMN SARSCOV2 BIVALENT 25 MCG/0.25 ML 1ST 0141A CDM 771 RC 0141A HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price 0141A IM ADMN SARSCOV2 BIVALENT 25 MCG/0.25 ML 1ST 0141A CDM 771 RC 0141A HCPCS facility both 101 101 Gross Charge Type: NIHD_Clinic_Price 0184T EXC RECTAL TUMOR/TRANSANAL ENDOSCOPIC 0184T CDM 982 RC 0184T HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price 0184T EXC RECTAL TUMOR/TRANSANAL ENDOSCOPIC 0184T CDM 982 RC 0184T HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price Xpress MVP (GeneXpert) 0352U CDM 306 RC 0352U HCPCS facility both 210 210 Gross Charge Type: NIHD_RHC_Price Xpress MVP (GeneXpert) 0352U CDM 306 RC 0352U HCPCS facility both 210 210 Gross Charge Type: NIHD_Clinic_Price Cepheid Multiplex Vaginal Panel (MVP) 0352U CDM 306 RC facility both 210 210 Gross Charge Type: NIHD_Hosp_Profee_Price Cepheid Multiplex Vaginal Panel (MVP) 0352U CDM 306 RC facility both 210 210 Gross Charge Type: NIHD_Hosp_Profee_Price "Vista Cervical Collar Set with Extra Replacement Pads, One Size Fits All" 1000072 CDM 272 RC facility both 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price "Vista Cervical Collar Set with Extra Replacement Pads, One Size Fits All" 1000072 CDM 272 RC facility both 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Thyroid 100051 CDM 361 RC facility both TC 1068 1068 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Thyroid 100051 CDM 361 RC facility both TC 1068 1068 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Thyroid - Report 100052 CDM 975 RC 10005 HCPCS facility both 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Thyroid - Report 100052 CDM 975 RC 10005 HCPCS facility both 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US BIOPSY THYROID EACH ADDL LESION 10006 CDM 402 RC facility both TC 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US BIOPSY THYROID EACH ADDL LESION 10006 CDM 402 RC facility both TC 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price 10007 FINE NDL ASPIRATION BX W/FLUOR GDN 1ST L CHARGE 10007 CDM 361 RC facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price 10007 FINE NDL ASPIRATION BX W/FLUOR GDN 1ST L CHARGE 10007 CDM 361 RC facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price 10008 FINE NDL ASPIRATION BX W/FLUOR GDN EA AD CHARGE 10008 CDM 361 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price 10008 FINE NDL ASPIRATION BX W/FLUOR GDN EA AD CHARGE 10008 CDM 361 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price "10021 Fine needle aspiration biopsy, w/o imaging guidance; 1st lesion" 10021 CDM 450 RC facility both 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price "10021 Fine needle aspiration biopsy, w/o imaging guidance; 1st lesion" 10021 CDM 450 RC facility both 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price 10021 Fine needle aspiration; without imaging guidance 100211 CDM 521 RC 10021 HCPCS facility both 356 356 Gross Charge Type: NIHD_RHC_Price 10021 Fine needle aspiration; without imaging guidance 100211 CDM 521 RC 10021 HCPCS facility both 398 398 Gross Charge Type: NIHD_Clinic_Price 10021 FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE ProFee 100212 CDM 982 RC 10021 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 10021 FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE ProFee 100212 CDM 982 RC 10021 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Abscess or Cyst Soft Tissue 100301 CDM 761 RC facility both TC 2619 2619 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Abscess or Cyst Soft Tissue 100301 CDM 761 RC facility both TC 2619 2619 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Abscess or Cyst Soft Tissue - Report 100302 CDM 982 RC 10030 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Abscess or Cyst Soft Tissue - Report 100302 CDM 982 RC 10030 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Abscess or Cyst Soft Tissue 100303 CDM 761 RC facility both TC 2619 2619 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Abscess or Cyst Soft Tissue 100303 CDM 761 RC facility both TC 2619 2619 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Abscess or Cyst Soft Tissue - Report 100304 CDM 982 RC 10030 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Abscess or Cyst Soft Tissue - Report 100304 CDM 982 RC 10030 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "10030 IMAGE-GUIDED FLUID COLLECTION DRAINAGE BY CATHETER (EG, ABSCESS, HEMATOMA, SEROMA, LYM ProFee" 100305 CDM 982 RC 10030 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "10030 IMAGE-GUIDED FLUID COLLECTION DRAINAGE BY CATHETER (EG, ABSCESS, HEMATOMA, SEROMA, LYM ProFee" 100305 CDM 982 RC 10030 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 10040 Acne Surgery 10040 CDM 521 RC 10040 HCPCS facility both 183 183 Gross Charge Type: NIHD_RHC_Price 10040 Acne Surgery 10040 CDM 521 RC 10040 HCPCS facility both 183 183 Gross Charge Type: NIHD_Clinic_Price physostigmine 1 mg/mL Inj Sol [INYO] 10046 CDM J3490 HCPCS 17478-0510-02 NDC facility both 2 ML 751.54 751.54 Gross Charge Type: Pharmacy 10060 Incision and drainage of abscess; simple or single 100601 CDM 521 RC 10060 HCPCS facility both 582 582 Gross Charge Type: NIHD_RHC_Price 10060 Incision and drainage of abscess; simple or single 100601 CDM 521 RC 10060 HCPCS facility both 250 250 Gross Charge Type: NIHD_Clinic_Price 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee 100602 CDM 450 RC facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee 100602 CDM 450 RC facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price 10060 I&D ABSC; SMPL OR SINGLE CHARGE 100603 CDM 761 RC facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price 10060 I&D ABSC; SMPL OR SINGLE CHARGE 100603 CDM 761 RC facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "10060 INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS O ProFee" 100604 CDM 982 RC 10060 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "10060 INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS O ProFee" 100604 CDM 982 RC 10060 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 10061 Incision and drainage of abscess; complicated or multiple 100611 CDM 521 RC 10061 HCPCS facility both 832 832 Gross Charge Type: NIHD_RHC_Price 10061 Incision and drainage of abscess; complicated or multiple 100611 CDM 521 RC 10061 HCPCS facility both 832 832 Gross Charge Type: NIHD_Clinic_Price 10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee 100612 CDM 450 RC facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price 10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee 100612 CDM 450 RC facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price 10061 I&D ABSC; COMPL/MULTI CHARGE 100613 CDM 761 RC facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price 10061 I&D ABSC; COMPL/MULTI CHARGE 100613 CDM 761 RC facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price "10061 INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS O ProFee" 100614 CDM 982 RC 10061 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "10061 INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS O ProFee" 100614 CDM 982 RC 10061 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE TechFee 100801 CDM 450 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE TechFee 100801 CDM 450 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 10080 I+D PILONIDAL CYST SIMPLE CHARGE 100802 CDM 761 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 10080 I+D PILONIDAL CYST SIMPLE CHARGE 100802 CDM 761 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 10080 INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE ProFee 100803 CDM 982 RC 10080 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 10080 INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE ProFee 100803 CDM 982 RC 10080 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 10080 Incision and drainage of pilonidal cyst; simple 100804 CDM 521 RC 10080 HCPCS facility both 411 411 Gross Charge Type: NIHD_RHC_Price 10080 Incision and drainage of pilonidal cyst; simple 100804 CDM 521 RC 10080 HCPCS facility both 411 411 Gross Charge Type: NIHD_Clinic_Price 10081-I&D Pilonidal Cyst Complicated 10081 CDM 450 RC facility both 1603 1603 Gross Charge Type: NIHD_Hosp_Profee_Price 10081-I&D Pilonidal Cyst Complicated 10081 CDM 450 RC facility both 1603 1603 Gross Charge Type: NIHD_Hosp_Profee_Price 10081 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED TechFee 100811 CDM 450 RC facility both 1603 1603 Gross Charge Type: NIHD_Hosp_Profee_Price 10081 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED TechFee 100811 CDM 450 RC facility both 1603 1603 Gross Charge Type: NIHD_Hosp_Profee_Price 10081 I+D PILONIDAL CYST COMPLICATED CHARGE 100812 CDM 761 RC facility both 1603 1603 Gross Charge Type: NIHD_Hosp_Profee_Price 10081 I+D PILONIDAL CYST COMPLICATED CHARGE 100812 CDM 761 RC facility both 1603 1603 Gross Charge Type: NIHD_Hosp_Profee_Price 10081 Incision and drainage of pilonidal cyst; complicated 100813 CDM 521 RC 10081 HCPCS facility both 552 552 Gross Charge Type: NIHD_RHC_Price 10081 Incision and drainage of pilonidal cyst; complicated 100813 CDM 521 RC 10081 HCPCS facility both 552 552 Gross Charge Type: NIHD_Clinic_Price "HCV RNA Diagnosis, NAA LC" 10085465 CDM 300 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price "HCV RNA Diagnosis, NAA LC" 10085465 CDM 300 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price BARD SOFT MESH 6 X 6 (15CM X 15 CM) RECTANGLE 10112720 CDM 272 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price BARD SOFT MESH 6 X 6 (15CM X 15 CM) RECTANGLE 10112720 CDM 272 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price 3D MAX MID ANATOMICAL MESH RIGHT LARGE 10116311 CDM 278 RC facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price 3D MAX MID ANATOMICAL MESH RIGHT LARGE 10116311 CDM 278 RC facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price 3D MAX MID ANATOMICAL MESH LG LEFT 10116312 CDM 278 RC facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price 3D MAX MID ANATOMICAL MESH LG LEFT 10116312 CDM 278 RC facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price 3D MAX MID ANATOMICAL MESH XTRA LARGE LT 10116313 CDM 278 RC facility both 1313 1313 Gross Charge Type: NIHD_Hosp_Profee_Price 3D MAX MID ANATOMICAL MESH XTRA LARGE LT 10116313 CDM 278 RC facility both 1313 1313 Gross Charge Type: NIHD_Hosp_Profee_Price 3D MAX MID ANATOMICAL MESH XTRA LARGE RT 10116322 CDM 278 RC facility both 1313 1313 Gross Charge Type: NIHD_Hosp_Profee_Price 3D MAX MID ANATOMICAL MESH XTRA LARGE RT 10116322 CDM 278 RC facility both 1313 1313 Gross Charge Type: NIHD_Hosp_Profee_Price Celiac Disease HLA DQ Assoc. LC 10116324 CDM 301 RC facility both 112.4 112.4 Gross Charge Type: NIHD_Hosp_Profee_Price Celiac Disease HLA DQ Assoc. LC 10116324 CDM 301 RC facility both 112.4 112.4 Gross Charge Type: NIHD_Hosp_Profee_Price Celiac Disease Ab Screen w/Rfx LC 10116341 CDM 301 RC facility both 4.32 4.32 Gross Charge Type: NIHD_Hosp_Profee_Price Celiac Disease Ab Screen w/Rfx LC 10116341 CDM 301 RC facility both 4.32 4.32 Gross Charge Type: NIHD_Hosp_Profee_Price "Ethyl Glucuronide, Ur LC" 10116354 CDM 301 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price "Ethyl Glucuronide, Ur LC" 10116354 CDM 301 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price "10120 Incision and removal of foreign body, subcutaneous tissues; simple" 101201 CDM 521 RC 10120 HCPCS facility both 501 501 Gross Charge Type: NIHD_RHC_Price "10120 Incision and removal of foreign body, subcutaneous tissues; simple" 101201 CDM 521 RC 10120 HCPCS facility both 501 501 Gross Charge Type: NIHD_Clinic_Price 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee 101202 CDM 450 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee 101202 CDM 450 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "10120 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE ProFee" 101203 CDM 982 RC 10120 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "10120 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE ProFee" 101203 CDM 982 RC 10120 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price 10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL TechFee 101211 CDM 450 RC facility both 2832 2832 Gross Charge Type: NIHD_Hosp_Profee_Price 10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL TechFee 101211 CDM 450 RC facility both 2832 2832 Gross Charge Type: NIHD_Hosp_Profee_Price "10121 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED ProFee" 101212 CDM 982 RC 10121 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "10121 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED ProFee" 101212 CDM 982 RC 10121 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "10140 Incision and drainage of hematoma, seroma or fluid collection" 101401 CDM 521 RC 10140 HCPCS facility both 832 832 Gross Charge Type: NIHD_RHC_Price "10140 Incision and drainage of hematoma, seroma or fluid collection" 101401 CDM 521 RC 10140 HCPCS facility both 832 832 Gross Charge Type: NIHD_Clinic_Price 10140 I&D HEMATOMA SEROMA/FLUID COLLECTION TechFee 101402 CDM 450 RC facility both 2620 2620 Gross Charge Type: NIHD_Hosp_Profee_Price 10140 I&D HEMATOMA SEROMA/FLUID COLLECTION TechFee 101402 CDM 450 RC facility both 2620 2620 Gross Charge Type: NIHD_Hosp_Profee_Price I&D Hematoma Charge 101403 CDM 761 RC facility both 2620 2620 Gross Charge Type: NIHD_Hosp_Profee_Price I&D Hematoma Charge 101403 CDM 761 RC facility both 2620 2620 Gross Charge Type: NIHD_Hosp_Profee_Price "10140 INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION ProFee" 101404 CDM 982 RC 10140 HCPCS facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price "10140 INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION ProFee" 101404 CDM 982 RC 10140 HCPCS facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price "10160 Puncture aspiration of abscess, hematoma, bulla, or cyst" 101601 CDM 521 RC 10160 HCPCS facility both 234 234 Gross Charge Type: NIHD_RHC_Price "10160 Puncture aspiration of abscess, hematoma, bulla, or cyst" 101601 CDM 521 RC 10160 HCPCS facility both 234 234 Gross Charge Type: NIHD_Clinic_Price 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST TechFee 101602 CDM 450 RC facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST TechFee 101602 CDM 450 RC facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price "10160 PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST ProFee" 101603 CDM 982 RC 10160 HCPCS facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price "10160 PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST ProFee" 101603 CDM 982 RC 10160 HCPCS facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price CT Aspiration Abscess/Hematoma/Cyst 101604 CDM 761 RC facility both TC 619 619 Gross Charge Type: NIHD_Hosp_Profee_Price CT Aspiration Abscess/Hematoma/Cyst 101604 CDM 761 RC facility both TC 619 619 Gross Charge Type: NIHD_Hosp_Profee_Price CT Aspiration Abscess/Hematoma/Cyst - Report 101605 CDM 972 RC 10160 HCPCS facility both 26 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price CT Aspiration Abscess/Hematoma/Cyst - Report 101605 CDM 972 RC 10160 HCPCS facility both 26 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price "10180 Incision and drainage, complex, postoperative wound infection" 101801 CDM 521 RC 10180 HCPCS facility both 775 775 Gross Charge Type: NIHD_RHC_Price "10180 Incision and drainage, complex, postoperative wound infection" 101801 CDM 521 RC 10180 HCPCS facility both 775 775 Gross Charge Type: NIHD_Clinic_Price "10180 INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION ProFee" 101802 CDM 982 RC 10180 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "10180 INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION ProFee" 101802 CDM 982 RC 10180 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "Viral Hepatitis Screening and Diagnosis (HBV, HCV) LC 144025" 10180711 CDM 301 RC facility both 18.24 18.24 Gross Charge Type: NIHD_Hosp_Profee_Price "Viral Hepatitis Screening and Diagnosis (HBV, HCV) LC 144025" 10180711 CDM 301 RC facility both 18.24 18.24 Gross Charge Type: NIHD_Hosp_Profee_Price Hearing Screen POC 1019764 CDM 521 RC 92551 HCPCS facility both 73 73 Gross Charge Type: NIHD_Clinic_Price "HAV, HBV Immunity LC" 10199499 CDM 301 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price "HAV, HBV Immunity LC" 10199499 CDM 301 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price HEYMAN DISPOSABLE DILATORS 10 THRU 24 FR STRAIGHT TIP 1021100 CDM 272 RC facility both 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price HEYMAN DISPOSABLE DILATORS 10 THRU 24 FR STRAIGHT TIP 1021100 CDM 272 RC facility both 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price sodium polystyrene sulfonate 15 g/60 mL Sus UD [INYO] 10215 CDM 46287-0006-60 NDC facility both 60 ML 109.63 109.63 Gross Charge Type: Pharmacy sodium polystyrene sulfonate 15 g/60 mL Sus UD [INYO] 10215 CDM 00574-2003-02 NDC facility both 60 ML 56.25 56.25 Gross Charge Type: Pharmacy 86037 Antineutrophil Cytoplasmic Antibody (ANCA) Profile LC 10230921 CDM 301 RC 86037 HCPCS facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price 86037 Antineutrophil Cytoplasmic Antibody (ANCA) Profile LC 10230921 CDM 301 RC 86037 HCPCS facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price Phosphatidylethanol (PEth) LC 10253576 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Phosphatidylethanol (PEth) LC 10253576 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER HEMATURIA 3 WAY 22FR 1025522 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER HEMATURIA 3 WAY 22FR 1025522 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Amphetamines 10257397 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Amphetamines 10257397 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Barbiturates 10257398 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Barbiturates 10257398 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Cannabinoids 10257399 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Cannabinoids 10257399 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Cocaines 10257400 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Cocaines 10257400 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Opiates 10257401 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Opiates 10257401 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Benzodiazepines 10258728 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Benzodiazepines 10258728 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Methadones 10258729 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Methadones 10258729 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 PCP 10258730 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 PCP 10258730 CDM 300 RC 80307 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Propoxyphene 10258731 CDM 300 RC 80307 HCPCS facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price 80307 Propoxyphene 10258731 CDM 300 RC 80307 HCPCS facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price NIFEdipine 30 mg ER Tab [INYO] 10268 CDM 68084-0597-01 NDC facility both 1 EA 10.73 10.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB NIFEdipine 30 mg ER Tab [INYO] 10268 CDM 50268-0597-15 NDC facility both 1 EA 7.87 7.87 Gross Charge Type: Pharmacy | NDC EA = 1 TAB niMODipine 30 mg Cap [INYO] 10271 CDM 68084-0912-32 NDC facility both 1 EA 93.53 93.53 Gross Charge Type: Pharmacy | NDC EA = 1 CAP niMODipine 30 mg Cap 10271 CDM 69452-0209-13 NDC facility both 1 EA 96.17 96.17 Gross Charge Type: Pharmacy | NDC EA = 1 CAP niMODipine 30 mg Cap [INYO] 10271 CDM 23155-0108-30 NDC facility both 1 EA 96.17 96.17 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "Antigliadin Abs, IgG LC" 10312875 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price "Antigliadin Abs, IgG LC" 10312875 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price procainamide 500 mg/mL Inj Sol [INYO] 10342 CDM J2690 HCPCS 14789-0900-02 NDC facility both 2 ML 1520 1520 Gross Charge Type: Pharmacy procainamide 500 mg/mL Inj Sol [INYO] 10342 CDM J2690 HCPCS 00409-1903-41 NDC facility both 2 ML 1520 1520 Gross Charge Type: Pharmacy T001-IgE Maple/Box Elder LC 10359780 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T001-IgE Maple/Box Elder LC 10359780 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T070-IgE White Mulberry LC 10359794 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T070-IgE White Mulberry LC 10359794 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price sodium bicarbonate 4.2% IV Sol 10 mL [INYO] 10382 CDM 00409-5534-14 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy sodium bicarbonate 4.2% IV Sol 10 mL [INYO] 10382 CDM 00409-5534-34 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy ARTIFICIAL TEARS 1.4% DROPS [INYO] 10403 CDM 00536-1084-94 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS ARTIFICIAL TEARS 1.4% DROPS [INYO] 10403 CDM 17478-0060-12 NDC facility both 1 EA 38.46 38.46 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS 83516-Antineutrophil Cytoplasmic Antibody (ANCA) Profile LC 10446871 CDM 301 RC 83516 HCPCS facility both 33.63 33.63 Gross Charge Type: NIHD_Hosp_Profee_Price 83516-Antineutrophil Cytoplasmic Antibody (ANCA) Profile LC 10446871 CDM 301 RC 83516 HCPCS facility both 33.63 33.63 Gross Charge Type: NIHD_Hosp_Profee_Price "84166 - IFE+Protein Electro, 24-Hr Ur LC" 10448874 CDM 301 RC 84166 HCPCS facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price "84166 - IFE+Protein Electro, 24-Hr Ur LC" 10448874 CDM 301 RC 84166 HCPCS facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price "86335 - IFE, Protein Electro, 24-Hr Ur LC 003467" 10448875 CDM 301 RC 86335 HCPCS facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price "86335 - IFE, Protein Electro, 24-Hr Ur LC 003467" 10448875 CDM 301 RC 86335 HCPCS facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price "Coccidioides Abs, IgG/IgM, EIA LC" 10453378 CDM 301 RC facility both 9.89 9.89 Gross Charge Type: NIHD_Hosp_Profee_Price "Coccidioides Abs, IgG/IgM, EIA LC" 10453378 CDM 301 RC facility both 9.89 9.89 Gross Charge Type: NIHD_Hosp_Profee_Price T-Helper (CD4 Lymph) LC 10453383 CDM 301 RC facility both 18.73 18.73 Gross Charge Type: NIHD_Hosp_Profee_Price T-Helper (CD4 Lymph) LC 10453383 CDM 301 RC facility both 18.73 18.73 Gross Charge Type: NIHD_Hosp_Profee_Price Hemoglobpathy+Fer w/A Thal Rfx LC 10453390 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price Hemoglobpathy+Fer w/A Thal Rfx LC 10453390 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price "Zinc, RBC LC" 10453396 CDM 301 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price "Zinc, RBC LC" 10453396 CDM 301 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price "Respiratory Pathogen Panel, LC 139845" 10465237 CDM 301 RC facility both 61.25 61.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Respiratory Pathogen Panel, LC 139845" 10465237 CDM 301 RC facility both 61.25 61.25 Gross Charge Type: NIHD_Hosp_Profee_Price 87581 10465268 CDM 301 RC 87581 HCPCS facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price 87581 10465268 CDM 301 RC 87581 HCPCS facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price 87633 10465269 CDM 301 RC 87633 HCPCS facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price 87633 10465269 CDM 301 RC 87633 HCPCS facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price 87798 10465270 CDM 301 RC 87798 HCPCS facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price 87798 10465270 CDM 301 RC 87798 HCPCS facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price Thrombin Time 015230 LC 10481995 CDM 301 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Thrombin Time 015230 LC 10481995 CDM 301 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Prostatic Acid Phosphatase (PAP) 004747 LC 10481996 CDM 301 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price Prostatic Acid Phosphatase (PAP) 004747 LC 10481996 CDM 301 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price Reptilase Time 117180 LC 10483875 CDM 301 RC facility both 58.24 58.24 Gross Charge Type: NIHD_Hosp_Profee_Price Reptilase Time 117180 LC 10483875 CDM 301 RC facility both 58.24 58.24 Gross Charge Type: NIHD_Hosp_Profee_Price calcium chloride 1000 mg/10mL Inj Sol [INYO] 10535 CDM 00409-1631-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy calcium chloride 1000 mg/10mL Inj Sol [INYO] 10535 CDM 00409-4928-34 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy calcium chloride 1000 mg/10mL Inj Sol [INYO] 10535 CDM 76329-3304-01 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy Dextrose 50% IV Sol 50 mL [INYO] 10536 CDM 76329-3302-01 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy Dextrose 50% IV Sol 50 mL [INYO] 10536 CDM 00409-7517-16 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy Dextrose 50% IV Sol 50 mL [INYO] 10536 CDM 76329-3301-01 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy EPINEPHrine 0.1 mg/mL Inj 10 mL Sol [INYO] 10538 CDM J0171 HCPCS 76329-3318-01 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy EPINEPHrine 0.1 mg/mL Inj 10 mL Sol [INYO] 10538 CDM J0171 HCPCS 00409-4921-34 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy EPINEPHrine 0.1 mg/mL Sol [inyo] 10538 CDM J0171 HCPCS 00409-4933-01 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy EPINEPHrine 0.1 mg/mL Inj 10 mL Sol [INYO] 10538 CDM J0171 HCPCS 76329-3316-01 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy carbidopa-levodopa 50 mg-200 mg ER Tab [INYO] 10549 CDM 68084-0282-01 NDC facility both 1 EA 9.49 9.49 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 50 mg-200 mg ER Tab [INYO] 10549 CDM 51079-0923-20 NDC facility both 1 EA 10.45 10.45 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 50 mg-200 mg ER Tab [INYO] 10549 CDM 62756-0457-88 NDC facility both 1 EA 10.83 10.83 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium chloride 10 mEq ER Tab [INYO] 10555 CDM 00904-7292-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium chloride 10 mEq ER Tab [INYO] 10555 CDM 00904-7085-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium chloride 10 mEq ER Tab [INYO] 10555 CDM 00245-5317-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "TRANSTRACHEAL CATHETER, CHILD, 14 G," 1060221 CDM 272 RC facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price "TRANSTRACHEAL CATHETER, CHILD, 14 G," 1060221 CDM 272 RC facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price albuterol 0.5% Inh Sol [INYO] 10604 CDM J7611 HCPCS 50383-0741-20 NDC facility both 20 ML 260 260 Gross Charge Type: Pharmacy Polar Care Kodiak with Intelli-Flo Shoulder Pad Regular 1060600 CDM 272 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price Polar Care Kodiak with Intelli-Flo Shoulder Pad Regular 1060600 CDM 272 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price Ice Therapy 1060700 CDM 272 RC facility both 280 280 Gross Charge Type: NIHD_Hosp_Profee_Price Polar Care Kodiak with Intelli-Flo XL Shoulder 1060700_1 CDM 272 RC facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price Ice Therapy 1060700_2 CDM 272 RC facility both 280 280 Gross Charge Type: NIHD_Hosp_Profee_Price albuterol 0.083% Inh Sol 3 mL [INYO] 10610 CDM J7613 HCPCS 76204-0200-01 NDC facility both 3 ML 8.39 8.39 Gross Charge Type: Pharmacy albuterol 2.5 mg/3 mL (0.083%) Sol 10610 CDM J7613 HCPCS 76204-0200-30 NDC facility both 3 ML 7.99 7.99 Gross Charge Type: Pharmacy albuterol 0.083% Inh Sol 3 mL [INYO] 10610 CDM J7613 HCPCS 00487-9501-01 NDC facility both 3 ML 6 6 Gross Charge Type: Pharmacy silver sulfADIAZINE Top 1% Crm [INYO] 10611 CDM 67877-0124-05 NDC facility both 1 EA 75.6 75.6 Gross Charge Type: Pharmacy | NDC EA = 50 APP silver sulfADIAZINE topical 1% Cre 10611 CDM 67877-0124-50 NDC facility both 1 EA 75.6 75.6 Gross Charge Type: Pharmacy | NDC EA = 50 APP silver sulfADIAZINE topical 1% Cre 10611 CDM 61570-0131-55 NDC facility both 1 EA 74.1 74.1 Gross Charge Type: Pharmacy | NDC EA = 50 APP silver sulfADIAZINE Top 1% Crm [INYO] 10611 CDM 61570-0131-50 NDC facility both 1 EA 82.7 82.7 Gross Charge Type: Pharmacy | NDC EA = 50 APP isradipine 2.5 mg Cap [INYO] 10621 CDM 16252-0539-01 NDC facility both 1 EA 8.19 8.19 Gross Charge Type: Pharmacy | NDC EA = 1 CAP sodium chloride 0.9% 3mL Inhalation Sol UD [INYO] 10625 CDM 76204-0300-03 NDC facility both 3 ML 36 36 Gross Charge Type: Pharmacy methylPREDNISolone 16 mg Tab [INYO] 10636 CDM J7509 HCPCS 59746-0003-14 NDC facility both 1 EA 18.63 18.63 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tobramycin 40 mg/mL Inj Sol [INYO] 10666 CDM J3260 HCPCS 67457-0473-22 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy tobramycin 40 mg/mL Inj Sol [INYO] 10666 CDM J3260 HCPCS 63323-0306-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy tobramycin 40 mg/mL Inj Sol [INYO] 10666 CDM J3260 HCPCS 36000-0244-25 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy tobramycin 1.2 g Inj [INYO] 10672 CDM J3260 HCPCS 39822-0412-01 NDC facility both 1 EA 1520 1520 Gross Charge Type: Pharmacy dexamethasone-tobramycin Ophth 0.1%-0.3% Susp [INYO] 10673 CDM 00574-4031-05 NDC facility both 1 EA 365.04 365.04 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS dexamethasone-tobramycin Ophth 0.1%-0.3% Susp [INYO] 10673 CDM 00065-0647-05 NDC facility both 1 EA 761.44 761.44 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS dexamethasone-tobramycin Ophth 0.1%-0.3% Susp [INYO] 10673 CDM 24208-0295-05 NDC facility both 1 EA 486.72 486.72 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS "NMO/AQP4 FACS, S LC" 10702520 CDM 301 RC facility both 651.4 651.4 Gross Charge Type: NIHD_Hosp_Profee_Price "NMO/AQP4 FACS, S LC" 10702520 CDM 301 RC facility both 651.4 651.4 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Sm Ab (RDL) LC 10714444 CDM 301 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Sm Ab (RDL) LC 10714444 CDM 301 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price benzocaine/butamben/tetracaine Top Aer [INYO] 10715 CDM 10223-0201-03 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 20 INH "Anti-Myelin Oligodendrocyte Glycoprotein (MOG), Serum LC" 10716927 CDM 301 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price "Anti-Myelin Oligodendrocyte Glycoprotein (MOG), Serum LC" 10716927 CDM 301 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price W010-IgE Lamb's Quarters LC 10721461 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price W010-IgE Lamb's Quarters LC 10721461 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T011-IgE Maple Leaf Sycamore LC 10721505 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T011-IgE Maple Leaf Sycamore LC 10721505 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price 83020 10735632 CDM 301 RC 83020 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price 83020 10735632 CDM 301 RC 83020 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price 85027 10735633 CDM 301 RC 85027 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price 85027 10735633 CDM 301 RC 85027 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price amoxicillin 250 mg/5 mL Oral Liq [INYO] 10755 CDM 00781-6041-55 NDC facility both 150 ML 42.36 42.36 Gross Charge Type: Pharmacy ceFAZolin 500 mg PWVL [INYO] 10762 CDM J0690 HCPCS 00143-9923-90 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy dexAMETHasone 4 mg Tab [inyo] 10773 CDM J8540 HCPCS 00904-7266-61 NDC facility both 1 EA 7.52 7.52 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dexamethasone 4 mg Tab [INYO] 10773 CDM J8540 HCPCS 00054-8175-25 NDC facility both 1 EA 7.23 7.23 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dexAMETHasone 4 mg Tab 10773 CDM J8540 HCPCS 66993-0730-80 NDC facility both 1 EA 7.23 7.23 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dexamethasone 4 mg Tab [INYO] 10773 CDM J8540 HCPCS 47781-0914-51 NDC facility both 1 EA 7.23 7.23 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dexamethasone 4 mg Tab [INYO] 10773 CDM J8540 HCPCS 48102-0047-20 NDC facility both 1 EA 7.23 7.23 Gross Charge Type: Pharmacy | NDC EA = 1 TAB erythromycin 250 mg Oral EC Tab [INYO] 10778 CDM 24338-0122-13 NDC facility both 1 EA 52.98 52.98 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "AChR Antibodies, Complete Profile LC" 10790990 CDM 301 RC facility both 30.34 30.34 Gross Charge Type: NIHD_Hosp_Profee_Price "AChR Antibodies, Complete Profile LC" 10790990 CDM 301 RC facility both 30.34 30.34 Gross Charge Type: NIHD_Hosp_Profee_Price ferrous gluconate 324 mg (37.5 mg elemental iron) Tab UD [INYO] 10792 CDM 00904-2137-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ferrous gluconate 324 mg (37.5 mg elemental iron) Tab UD [INYO] 10792 CDM 20555-0019-00 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB diphenhydrAMINE 50 mg/mL Inj Sol [INYO] 10794 CDM J1200 HCPCS 63323-0664-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy diphenhydrAMINE 50 mg/mL Inj Sol [INYO] 10794 CDM J1200 HCPCS 00641-0376-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy acetaminophen 650 mg Supp [INYO] 10795 CDM 45802-0730-32 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP acetaminophen 325 mg Tab [INYO] 10796 CDM 50580-0458-11 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 325 mg Tab [INYO] 10796 CDM 00536-1327-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 325 mg Tab [INYO] 10796 CDM 50580-0600-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 325 mg Tab [INYO] 10796 CDM 00536-1327-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 325 mg Tab [INYO] 10796 CDM 00904-6773-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 325 mg Tab [INYO] 10796 CDM 50580-0501-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB meperidine 100 mg/mL Inj Sol [INYO] 10814 CDM J2175 HCPCS 00641-6054-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy meperidine 100 mg/mL Inj Sol [INYO] 10814 CDM J2175 HCPCS 00409-1180-69 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy nitroglycerin 0.4 mg/hr Transderm ER Film [INYO] 10817 CDM 49730-0112-30 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nitroglycerin 0.3 mg/hr Transderm ER Film [INYO] 10818 CDM 00085-3315-35 NDC facility both 1 EA 31.5 31.5 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nitroglycerin 0.2 mg/hr Transderm ER Film [INYO] 10819 CDM 49730-0111-30 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nitroglycerin 0.2 mg/hr Transderm ER Film [INYO] 10819 CDM 00378-9104-93 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nitroglycerin 0.1 mg/hr Transderm ER Film [INYO] 10820 CDM 00085-3305-30 NDC facility both 1 EA 27.66 27.66 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nitroglycerin 0.1 mg/hr Transderm ER Film [INYO] 10820 CDM 00378-9102-93 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nitroglycerin 50 mg/10 mL IV Sol [INYO] 10825 CDM J2305 HCPCS 00517-4810-25 NDC facility both 10 ML 265 265 Gross Charge Type: Pharmacy naproxen 250 mg Tab [INYO] 10827 CDM 50268-0594-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB naproxen 250 mg Tab [INYO] 10827 CDM 68462-0188-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB naloxone 4 mg/10 mL Son [INYO] 10828 CDM J2310 HCPCS 00409-1219-01 NDC facility both 10 ML 1139.9 1139.9 Gross Charge Type: Pharmacy naloxone 4 mg/10 mL Son [INYO] 10828 CDM J2310 HCPCS 55150-0328-10 NDC facility both 10 ML 1196 1196 Gross Charge Type: Pharmacy naloxone 4 mg/10 mL Son [INYO] 10828 CDM J2310 HCPCS 70069-0072-10 NDC facility both 10 ML 1135.34 1135.34 Gross Charge Type: Pharmacy nitroglycerin 50 mg/250 mL-D5W IV Sol [INYO] 10830 CDM J2305 HCPCS 00338-1049-02 NDC facility both 250 ML 265 265 Gross Charge Type: Pharmacy oxybutynin 5 mg Tab [INYO] 10835 CDM 00832-0038-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxybutynin 5 mg Tab [INYO] 10835 CDM 00904-2821-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 86258 10835837 CDM 301 RC 86258 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price 86258 10835837 CDM 301 RC 86258 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price oxytocin 10 intl units/mL Inj Sol [INYO] 10836 CDM J2590 HCPCS 63323-0012-11 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy oxytocin 10 intl units/mL Inj Sol [INYO] 10836 CDM J2590 HCPCS 42023-0116-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy 86364 10838900 CDM 301 RC 86364 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price 86364 10838900 CDM 301 RC 86364 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price Fluoride LC 070060 10838929 CDM 301 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price Fluoride LC 070060 10838929 CDM 301 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price tuberculin purified protein derivative 5 TU/0.1 mL ID Sol [INYO] 10840 CDM 49281-0752-21 NDC facility both 1 ML 820.32 820.32 Gross Charge Type: Pharmacy tuberculin purified protein derivative 5 TU/0.1 mL ID Sol [INYO] 10840 CDM 42023-0104-01 NDC facility both 1 ML 852.8 852.8 Gross Charge Type: Pharmacy Penicillin V Potassium 250 mg Tab [INYO] 10842 CDM 65862-0175-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Penicillin V Potassium 250 mg Tab [INYO] 10842 CDM 00781-1205-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Amphetamines LC 10845757 CDM 301 RC 80307 HCPCS facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Amphetamines LC 10845757 CDM 301 RC 80307 HCPCS facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Penicillin V Potassium 250 mg/5 mL Pow [INYO] 10848 CDM 00093-4127-74 NDC facility both 200 ML 74 74 Gross Charge Type: Pharmacy SUMAtriptan 6 mg/0.5 mL SubQ Sol [INYO] 10867 CDM J3030 HCPCS 55150-0173-01 NDC facility both 0.5 ML 235 235 Gross Charge Type: Pharmacy 86357 10872071 CDM 301 RC 86357 HCPCS facility both 36 36 Gross Charge Type: NIHD_Hosp_Profee_Price 86357 10872071 CDM 301 RC 86357 HCPCS facility both 36 36 Gross Charge Type: NIHD_Hosp_Profee_Price Galectin-3 LC 004110 10872088 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price Galectin-3 LC 004110 10872088 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price "Fat Emul, 20% IV 250 mL [INYO]" 10886 CDM 00338-0519-09 NDC facility both 250 ML 395.1 395.1 Gross Charge Type: Pharmacy "Fat Emul, 20% IV 250 mL [INYO]" 10886 CDM 00264-4460-30 NDC facility both 250 ML 265 265 Gross Charge Type: Pharmacy amitriptyline 25 mg Tab [INYO] 10887 CDM 00904-0201-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amitriptyline 25 mg Tab [INYO] 10887 CDM 60687-0433-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amitriptyline 25 mg Tab [INYO] 10887 CDM 51079-0107-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amLODIPine 5 mg Tab [INYO] 10888 CDM 00904-6370-61 NDC facility both 1 EA 9.86 9.86 Gross Charge Type: Pharmacy | NDC EA = 1 TAB propranolol 20 mg Tab [INYO] 10907 CDM 50268-0663-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB propranolol 20 mg Tab [INYO] 10907 CDM 00904-6705-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB propranolol 20 mg Tab [INYO] 10907 CDM 23155-0111-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB propranolol 20 mg Tab [INYO] 10907 CDM 50268-0701-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "Human Herpesvirus 6 (HHV-6) Quantitation, DNA PCR LC 139310" 10936868 CDM 301 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price "Human Herpesvirus 6 (HHV-6) Quantitation, DNA PCR LC 139310" 10936868 CDM 301 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price 86706-Viral Hepatitis Immunity Profile (HAV and HBV) LC 028910 10961309 CDM 301 RC 86706 HCPCS facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price 86706-Viral Hepatitis Immunity Profile (HAV and HBV) LC 028910 10961309 CDM 301 RC 86706 HCPCS facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price 86708-Viral Hepatitis Immunity Profile (HAV and HBV) LC 028910 10961310 CDM 301 RC 86708 HCPCS facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price 86708-Viral Hepatitis Immunity Profile (HAV and HBV) LC 028910 10961310 CDM 301 RC 86708 HCPCS facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price "82533- Salivary Cortisol (Four Specimens), MS (Endocrine Sciences) LC 502124" 10961323 CDM 301 RC 82533 HCPCS facility both 123.8 123.8 Gross Charge Type: NIHD_Hosp_Profee_Price "82533- Salivary Cortisol (Four Specimens), MS (Endocrine Sciences) LC 502124" 10961323 CDM 301 RC 82533 HCPCS facility both 123.8 123.8 Gross Charge Type: NIHD_Hosp_Profee_Price 86317-Pneumococcal IM (14 Serotype) LC 816767 10966398 CDM 301 RC 86317 HCPCS facility both 23.1 23.1 Gross Charge Type: NIHD_Hosp_Profee_Price 86317-Pneumococcal IM (14 Serotype) LC 816767 10966398 CDM 301 RC 86317 HCPCS facility both 23.1 23.1 Gross Charge Type: NIHD_Hosp_Profee_Price "86635-Coccidioides immitis Antibodies, IgG and IgM, EIA LC 164798" 10974894 CDM 301 RC 86635 HCPCS facility both 9.89 9.89 Gross Charge Type: NIHD_Hosp_Profee_Price "86635-Coccidioides immitis Antibodies, IgG and IgM, EIA LC 164798" 10974894 CDM 301 RC 86635 HCPCS facility both 9.89 9.89 Gross Charge Type: NIHD_Hosp_Profee_Price "Prostaglandin D2, Serum LC 505530" 10974914 CDM 301 RC facility both 288.75 288.75 Gross Charge Type: NIHD_Hosp_Profee_Price "Prostaglandin D2, Serum LC 505530" 10974914 CDM 301 RC facility both 288.75 288.75 Gross Charge Type: NIHD_Hosp_Profee_Price sulfamethoxazole-trimethoprim 800 mg-160 mg Tab [INYO] 10980 CDM 00904-2725-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sulfamethoxazole-trimethoprim 800 mg-160 mg Tab [INYO] 10980 CDM 65162-0272-10 NDC facility both 1 EA 8.41 8.41 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Oral Susp [INYO] 10981 CDM 70954-0258-10 NDC facility both 20 ML 15.61 15.61 Gross Charge Type: Pharmacy sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Oral Susp [INYO] 10981 CDM 00121-0854-16 NDC facility both 20 ML 28.65 28.65 Gross Charge Type: Pharmacy sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Oral Susp [INYO] 10981 CDM 50383-0824-16 NDC facility both 20 ML 54.65 54.65 Gross Charge Type: Pharmacy prednisoLONE-sodium sulfacetamide Ophth 0.2%-10% Susp [INYO] 10986 CDM 11980-0022-05 NDC facility both 1 EA 733.25 733.25 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS benztropine 1 mg/mL Inj Sol [INYO] 10993 CDM J0515 HCPCS 17478-0012-02 NDC facility both 2 ML 476.72 476.72 Gross Charge Type: Pharmacy benztropine 1 mg/mL Inj Sol [INYO] 10993 CDM J0515 HCPCS 68382-0860-10 NDC facility both 2 ML 470 470 Gross Charge Type: Pharmacy 11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface 110001 CDM 521 RC 11000 HCPCS facility both 118 118 Gross Charge Type: NIHD_RHC_Price 11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface 110001 CDM 521 RC 11000 HCPCS facility both 116 116 Gross Charge Type: NIHD_Clinic_Price 11000 MD DEBRIDE UP TO 10 % BSA CHARGE 110002 CDM 761 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 11000 MD DEBRIDE UP TO 10 % BSA CHARGE 110002 CDM 761 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE ProFee 110003 CDM 982 RC 11000 HCPCS facility both 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price 11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE ProFee 110003 CDM 982 RC 11000 HCPCS facility both 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price 11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee 110004 CDM 450 RC facility both 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price 11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee 110004 CDM 450 RC facility both 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price "Cortisol, ACTH Stim (3 Spec) LC 380910" 11000923 CDM 301 RC facility both 6.84 6.84 Gross Charge Type: NIHD_Hosp_Profee_Price "Cortisol, ACTH Stim (3 Spec) LC 380910" 11000923 CDM 301 RC facility both 6.84 6.84 Gross Charge Type: NIHD_Hosp_Profee_Price 82533 11000933 CDM 301 RC 82533 HCPCS facility both 7 7 Gross Charge Type: NIHD_Hosp_Profee_Price 82533 11000933 CDM 301 RC 82533 HCPCS facility both 7 7 Gross Charge Type: NIHD_Hosp_Profee_Price 11001 MD DEBRIDE ADD 10 % BSA CHARGE 11001 CDM 761 RC facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price 11001 MD DEBRIDE ADD 10 % BSA CHARGE 11001 CDM 761 RC facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price 82397 11004041 CDM 301 RC 82397 HCPCS facility both 290 290 Gross Charge Type: NIHD_Hosp_Profee_Price 82397 11004041 CDM 301 RC 82397 HCPCS facility both 290 290 Gross Charge Type: NIHD_Hosp_Profee_Price "11005 Debride of skin, subQ tissue, muscle/fascia for necrotizing soft tissue infection; abd wall" 110051 CDM 521 RC 11005 HCPCS facility both 1380 1380 Gross Charge Type: NIHD_Clinic_Price "11005 DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING SOFT TISSU ProFee" 110052 CDM 982 RC 11005 HCPCS facility both 1380 1380 Gross Charge Type: NIHD_Hosp_Profee_Price "11005 DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING SOFT TISSU ProFee" 110052 CDM 982 RC 11005 HCPCS facility both 1380 1380 Gross Charge Type: NIHD_Hosp_Profee_Price "11008 REMOVAL OF PROSTHETIC MATERIAL OR MESH, ABDOMINAL WALL FOR INFECTION (EG, FOR CHRONIC ProFee" 11008 CDM 982 RC 11008 HCPCS facility both 486 486 Gross Charge Type: NIHD_Hosp_Profee_Price "11008 REMOVAL OF PROSTHETIC MATERIAL OR MESH, ABDOMINAL WALL FOR INFECTION (EG, FOR CHRONIC ProFee" 11008 CDM 982 RC 11008 HCPCS facility both 486 486 Gross Charge Type: NIHD_Hosp_Profee_Price 11010 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/ ProFee 11010 CDM 982 RC 11010 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price 11010 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/ ProFee 11010 CDM 982 RC 11010 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price gentamicin Ophth 0.3% Sol [INYO] 11010 CDM 61314-0633-05 NDC facility both 1 EA 130.2 130.2 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS gentamicin Ophth 0.3% Sol [INYO] 11010 CDM 24208-0580-60 NDC facility both 1 EA 257.1 257.1 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS 11011 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/ ProFee 11011 CDM 982 RC 11011 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 11011 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/ ProFee 11011 CDM 982 RC 11011 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 11012 DBRDMT FX&/DISLC SUBQ T/M/F BONE TechFee 110121 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 11012 DBRDMT FX&/DISLC SUBQ T/M/F BONE TechFee 110121 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 11012 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/ ProFee 110122 CDM 982 RC 11012 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price 11012 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/ ProFee 110122 CDM 982 RC 11012 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price Dengue Virus IgG and IgM LC 819213 11020869 CDM 301 RC facility both 53.5 53.5 Gross Charge Type: NIHD_Hosp_Profee_Price Dengue Virus IgG and IgM LC 819213 11020869 CDM 301 RC facility both 53.5 53.5 Gross Charge Type: NIHD_Hosp_Profee_Price Coccidioidal Serology LC 825569 11020880 CDM 301 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price Coccidioidal Serology LC 825569 11020880 CDM 301 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price 86790 11025881 CDM 301 RC 86790 HCPCS facility both 56 56 Gross Charge Type: NIHD_Hosp_Profee_Price 86790 11025881 CDM 301 RC 86790 HCPCS facility both 56 56 Gross Charge Type: NIHD_Hosp_Profee_Price 86635 11025908 CDM 301 RC 86635 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price 86635 11025908 CDM 301 RC 86635 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-U1 RNP Ab (RDL) LC 520034 11028512 CDM 301 RC facility both 34 34 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-U1 RNP Ab (RDL) LC 520034 11028512 CDM 301 RC facility both 34 34 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-MDA-5 Ab (CADM-140) (RDL) LC 520002 11028522 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-MDA-5 Ab (CADM-140) (RDL) LC 520002 11028522 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-PM/Scl-100 Ab (RDL) LC 520007 11038013 CDM 301 RC facility both 34.43 34.43 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-PM/Scl-100 Ab (RDL) LC 520007 11038013 CDM 301 RC facility both 34.43 34.43 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Mi-2 Ab (RDL) LC 520000 11038019 CDM 301 RC facility both 31.36 31.36 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Mi-2 Ab (RDL) LC 520000 11038019 CDM 301 RC facility both 31.36 31.36 Gross Charge Type: NIHD_Hosp_Profee_Price Magnesium Chloride w Calcium 112 mg-64 mg Tab [INYO] 11041 CDM 68585-0005-75 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB calcium carbonate-magnesium chloride 112 mg-64 mg Tab [inyo] 11041 CDM 10006-0700-13 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB mannitol 20% IV Sol 500 mL [INYO] 11042 CDM 00409-7715-03 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy mannitol 20% IV Sol 500 mL [INYO] 11042 CDM 00990-7715-13 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy "11042 Debridement, subcutaneous tissue; first 20 sq cm or less" 110421 CDM 521 RC 11042 HCPCS facility both 346 346 Gross Charge Type: NIHD_RHC_Price "11042 Debridement, subcutaneous tissue; first 20 sq cm or less" 110421 CDM 521 RC 11042 HCPCS facility both 347 347 Gross Charge Type: NIHD_Clinic_Price 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee 110422 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee 110422 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price "11042 DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST ProFee" 110423 CDM 982 RC 11042 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "11042 DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST ProFee" 110423 CDM 982 RC 11042 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "11043 DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE ProFee" 11043 CDM 982 RC 11043 HCPCS facility both 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price "11043 DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE ProFee" 11043 CDM 982 RC 11043 HCPCS facility both 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price mannitol 25% IV Sol 50 mL [INYO] 11043 CDM J2150 HCPCS 00409-4031-01 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy "11044 DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASC ProFee" 11044 CDM 982 RC 11044 HCPCS facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price "11044 DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASC ProFee" 11044 CDM 982 RC 11044 HCPCS facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price "11045 Debridement, subcutaneous tissue each additional 20 sq cm, or part thereof" 110451 CDM 521 RC 11045 HCPCS facility both 51 51 Gross Charge Type: NIHD_Clinic_Price "11045 DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH A ProFee" 110452 CDM 982 RC 11045 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price "11045 DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH A ProFee" 110452 CDM 982 RC 11045 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price "11046 Debridement, muscle and/or fascia; each additional 20 sq cm, or part thereof" 110461 CDM 521 RC 11046 HCPCS facility both 102 102 Gross Charge Type: NIHD_Clinic_Price "11046 DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE ProFee" 110462 CDM 982 RC 11046 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price "11046 DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE ProFee" 110462 CDM 982 RC 11046 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price "11047 DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASC ProFee" 11047 CDM 982 RC 11047 HCPCS facility both 179 179 Gross Charge Type: NIHD_Hosp_Profee_Price "11047 DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASC ProFee" 11047 CDM 982 RC 11047 HCPCS facility both 179 179 Gross Charge Type: NIHD_Hosp_Profee_Price 11055 Paring or cutting of benign hyperkeratotic lesion; single lesion 11055 CDM 521 RC 11055 HCPCS facility both 88 88 Gross Charge Type: NIHD_RHC_Price 11055 Paring or cutting of benign hyperkeratotic lesion; single lesion 11055 CDM 521 RC 11055 HCPCS facility both 88 88 Gross Charge Type: NIHD_Clinic_Price mupirocin Top 2% Oint [INYO] 11055 CDM 51672-1312-00 NDC facility both 1 EA 125 125 Gross Charge Type: Pharmacy | NDC EA = 22 APP mupirocin topical 2% Oin [inyo] 11055 CDM 68462-0180-22 NDC facility both 1 EA 213.75 213.75 Gross Charge Type: Pharmacy | NDC EA = 22 APP mupirocin Top 2% Oint [INYO] 11055 CDM 45802-0112-22 NDC facility both 1 EA 57.25 57.25 Gross Charge Type: Pharmacy | NDC EA = 22 APP "11055 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION ProFee" 110551 CDM 982 RC 11055 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price "11055 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION ProFee" 110551 CDM 982 RC 11055 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 11055 PARING OF BENIGN LESION - SINGLE LESION CHARGE 110552 CDM 761 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price 11055 PARING OF BENIGN LESION - SINGLE LESION CHARGE 110552 CDM 761 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price 11056 Paring or cutting of benign hyperkeratotic lesion; 2 to 4 lesions 11056 CDM 521 RC 11056 HCPCS facility both 132 132 Gross Charge Type: NIHD_RHC_Price 11056 Paring or cutting of benign hyperkeratotic lesion; 2 to 4 lesions 11056 CDM 521 RC 11056 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price "11057 Paring or cutting of benign hyperkeratotic lesion (eg, corn" 11057 CDM 521 RC 11057 HCPCS facility both 159 159 Gross Charge Type: NIHD_RHC_Price "11057 Paring or cutting of benign hyperkeratotic lesion (eg, corn" 11057 CDM 521 RC 11057 HCPCS facility both 159 159 Gross Charge Type: NIHD_Clinic_Price Anti-Jo-1 Ab (RDL) LC 520032 11060555 CDM 301 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 Ab (RDL) LC 520032 11060555 CDM 301 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price tetracaine 1% Inj Sol 2 mL [INYO] 11070 CDM 17478-0045-32 NDC facility both 2 ML 729.03 729.03 Gross Charge Type: Pharmacy potassium phosphate 3 mmol/mL IV Sol [INYO] 11072 CDM 63323-0086-05 NDC facility both 5 ML 330 330 Gross Charge Type: Pharmacy neostigmine 1 mg/mL Sol [INYO] 11080 CDM J2710 HCPCS 70121-1479-07 NDC facility both 10 ML 249.6 249.6 Gross Charge Type: Pharmacy neostigmine 1 mg/mL Sol [INYO] 11080 CDM J2710 HCPCS 71839-0106-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy neostigmine 1 mg/mL Sol [inyo] 11080 CDM J2710 HCPCS 42023-0189-10 NDC facility both 10 ML 415 415 Gross Charge Type: Pharmacy neostigmine 1 mg/mL [INYO] 11080 CDM J2710 HCPCS 00548-9602-00 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy neostigmine 1 mg/mL [INYO] 11080 CDM J2710 HCPCS 70700-0172-23 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy neostigmine 1 mg/mL [INYO] 11080 CDM J2710 HCPCS 76014-0003-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy sodium acetate 2 mEq/mL IV Sol [INYO] 11094 CDM J3490 HCPCS 00409-7299-73 NDC facility both 20 ML 330 330 Gross Charge Type: Pharmacy "11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion" 11102 CDM 521 RC 11102 HCPCS facility both 277 277 Gross Charge Type: NIHD_RHC_Price "11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion" 11102 CDM 521 RC 11102 HCPCS facility both 277 277 Gross Charge Type: NIHD_Clinic_Price EPINEPHrine 1 mg/mL 1 mL Sol [INYO] 11102 CDM J0171 HCPCS 42023-0159-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy "11102 Tangential Biopsy of Skin, 1 lesion" 111021 CDM 761 RC facility both 463 463 Gross Charge Type: NIHD_Hosp_Profee_Price "11102 Tangential Biopsy of Skin, 1 lesion" 111021 CDM 761 RC facility both 463 463 Gross Charge Type: NIHD_Hosp_Profee_Price 11102 TANGENTIAL BIOPSY OF SKIN ProFee 111022 CDM 982 RC 11102 HCPCS facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price 11102 TANGENTIAL BIOPSY OF SKIN ProFee 111022 CDM 982 RC 11102 HCPCS facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price "11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional les" 11103 CDM 521 RC 11103 HCPCS facility both 88 88 Gross Charge Type: NIHD_RHC_Price "11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional les" 11103 CDM 521 RC 11103 HCPCS facility both 88 88 Gross Charge Type: NIHD_Clinic_Price 11103 TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION ProFee 111031 CDM 982 RC 11103 HCPCS facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price 11103 TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION ProFee 111031 CDM 982 RC 11103 HCPCS facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price "11104 Punch biopsy of skin (including simple closure, when performed); single lesion" 11104 CDM 521 RC 11104 HCPCS facility both 277 277 Gross Charge Type: NIHD_RHC_Price "11104 Punch biopsy of skin (including simple closure, when performed); single lesion" 11104 CDM 521 RC 11104 HCPCS facility both 277 277 Gross Charge Type: NIHD_Clinic_Price "11104 Punch biopsy of skin (including simple closure, when performed); single lesion PIKE" 111041 CDM 761 RC facility both 580 580 Gross Charge Type: NIHD_Hosp_Profee_Price "11104 Punch biopsy of skin (including simple closure, when performed); single lesion PIKE" 111041 CDM 761 RC facility both 580 580 Gross Charge Type: NIHD_Hosp_Profee_Price "11100 BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), ProFee" 111042 CDM 982 RC 11104 HCPCS facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price "11100 BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), ProFee" 111042 CDM 982 RC 11104 HCPCS facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price "11105 Punch biopsy of skin (including simple closure, when performed); each separate/additional lesi" 11105 CDM 521 RC 11105 HCPCS facility both 88 88 Gross Charge Type: NIHD_RHC_Price "11105 Punch biopsy of skin (including simple closure, when performed); each separate/additional lesi" 11105 CDM 521 RC 11105 HCPCS facility both 88 88 Gross Charge Type: NIHD_Clinic_Price "11105 Punch Biopsy of Skin, each add lesion-WC Charge" 111051 CDM 761 RC facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price "11105 Punch Biopsy of Skin, each add lesion-WC Charge" 111051 CDM 761 RC facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price "11101 BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), ProFee" 111052 CDM 982 RC 11105 HCPCS facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price "11101 BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), ProFee" 111052 CDM 982 RC 11105 HCPCS facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD MG/US BIOPSY SKIN 11106 CDM 761 RC facility both TC 997 997 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD MG/US BIOPSY SKIN 11106 CDM 761 RC facility both TC 997 997 Gross Charge Type: NIHD_Hosp_Profee_Price "11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesi" 111061 CDM 521 RC 11106 HCPCS facility both 277 277 Gross Charge Type: NIHD_RHC_Price "11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesi" 111061 CDM 521 RC 11106 HCPCS facility both 277 277 Gross Charge Type: NIHD_Clinic_Price 11106 INCISIONAL BIOPSY SKIN SINGLE LESION CHARGE 111062 CDM 761 RC facility both 1143 1143 Gross Charge Type: NIHD_Hosp_Profee_Price 11106 INCISIONAL BIOPSY SKIN SINGLE LESION CHARGE 111062 CDM 761 RC facility both 1143 1143 Gross Charge Type: NIHD_Hosp_Profee_Price "11107 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separat" 111071 CDM 521 RC 11107 HCPCS facility both 88 88 Gross Charge Type: NIHD_RHC_Price "11107 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separat" 111071 CDM 521 RC 11107 HCPCS facility both 88 88 Gross Charge Type: NIHD_Clinic_Price 11107 INCISIONAL BIOPSY SKIN EA SEP/ADDL LSN CHARGE 111072 CDM 761 RC facility both 604 604 Gross Charge Type: NIHD_Hosp_Profee_Price 11107 INCISIONAL BIOPSY SKIN EA SEP/ADDL LSN CHARGE 111072 CDM 761 RC facility both 604 604 Gross Charge Type: NIHD_Hosp_Profee_Price cyanocobalamin 1000 mcg/mL Inj Sol [INYO] 11118 CDM J3420 HCPCS 63323-0044-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy cyanocobalamin 1000 mcg/mL Inj Sol [INYO] 11118 CDM J3420 HCPCS 70069-0005-10 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy "11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions" 111201 CDM 521 RC 11200 HCPCS facility both 501 501 Gross Charge Type: NIHD_RHC_Price "11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions" 111201 CDM 521 RC 11200 HCPCS facility both 139 139 Gross Charge Type: NIHD_Clinic_Price "T-Cell Activation Profile, CD8 Subsets LC 505750" 11120101 CDM 301 RC facility both 50.5 50.5 Gross Charge Type: NIHD_Hosp_Profee_Price "T-Cell Activation Profile, CD8 Subsets LC 505750" 11120101 CDM 301 RC facility both 50.5 50.5 Gross Charge Type: NIHD_Hosp_Profee_Price 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 TechFee 111202 CDM 450 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 TechFee 111202 CDM 450 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price "11200 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 L ProFee" 111203 CDM 982 RC 11200 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price "11200 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 L ProFee" 111203 CDM 982 RC 11200 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price "86356 T-Cell Activation Profile, CD8 Subsets LC 505750" 11120471 CDM 301 RC 86356 HCPCS facility both 50.5 50.5 Gross Charge Type: NIHD_Hosp_Profee_Price "86356 T-Cell Activation Profile, CD8 Subsets LC 505750" 11120471 CDM 301 RC 86356 HCPCS facility both 50.5 50.5 Gross Charge Type: NIHD_Hosp_Profee_Price "86360 T-Cell Activation Profile, CD8 Subsets LC 505750" 11129015 CDM 301 RC 86360 HCPCS facility both 50.5 50.5 Gross Charge Type: NIHD_Hosp_Profee_Price "86360 T-Cell Activation Profile, CD8 Subsets LC 505750" 11129015 CDM 301 RC 86360 HCPCS facility both 50.5 50.5 Gross Charge Type: NIHD_Hosp_Profee_Price sodium sulfacetamide Ophth 10% Sol [INYO] 11131 CDM 24208-0670-04 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS HYDROmorphone 2 mg/mL Inj Sol vial [INYO] 11141 CDM J1170 HCPCS 00409-3365-10 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy HYDROmorphone 2 mg/mL Inj Sol vial [INYO] 11141 CDM J1170 HCPCS 00641-0121-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy HYDROmorphone 2 mg/mL Inj Sol vial [INYO] 11141 CDM J1170 HCPCS 00641-6151-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy HYDROmorphone 2 mg/mL Inj Sol vial [INYO] 11141 CDM J1170 HCPCS 63323-0853-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy HYDROmorphone 2 mg Tab [INYO] 11142 CDM 60687-0579-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB HYDROmorphone 2 mg Tab [INYO] 11142 CDM 00406-3243-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB HYDROmorphone 2 mg Tab [INYO] 11142 CDM 42858-0301-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB HYDROmorphone 2 mg Tab [INYO] 11142 CDM 68084-0423-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydroxypropyl methylcellulose Ophth 2.5% Sol [INYO] 11143 CDM 17478-0064-12 NDC facility both 1 EA 105.7 105.7 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS "HSV 1 and 2 Ab, IgG LC" 11148936 CDM 301 RC facility both 20 20 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV 1 and 2 Ab, IgG LC" 11148936 CDM 301 RC facility both 20 20 Gross Charge Type: NIHD_Hosp_Profee_Price 86602 Hypersensitivity Pneumonitis Profile LC 660670 11149648 CDM 300 RC 86602 HCPCS facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price 86602 Hypersensitivity Pneumonitis Profile LC 660670 11149648 CDM 300 RC 86602 HCPCS facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price 86606 Hypersensitivity Pneumonitis Profile LC 660670 11149650 CDM 300 RC 86606 HCPCS facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price 86606 Hypersensitivity Pneumonitis Profile LC 660670 11149650 CDM 300 RC 86606 HCPCS facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price 86671 Hypersensitivity Pneumonitis Profile LC 660670 11149651 CDM 300 RC 86671 HCPCS facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price 86671 Hypersensitivity Pneumonitis Profile LC 660670 11149651 CDM 300 RC 86671 HCPCS facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price hydrocortisone Top 2.5% Crm [INYO] 11150 CDM 00168-0080-31 NDC facility both 1 EA 55 55 Gross Charge Type: Pharmacy | NDC EA = 30 APP hydrocortisone Top 2.5% Crm [INYO] 11150 CDM 69315-0312-28 NDC facility both 1 EA 360 360 Gross Charge Type: Pharmacy | NDC EA = 30 APP hydrocortisone Top 2.5% Crm [INYO] 11150 CDM 00472-0337-30 NDC facility both 1 EA 55 55 Gross Charge Type: Pharmacy | NDC EA = 30 APP 86609 Hypersensitivity Pneumonitis Profile LC 660670 11151024 CDM 300 RC 86609 HCPCS facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price 86609 Hypersensitivity Pneumonitis Profile LC 660670 11151024 CDM 300 RC 86609 HCPCS facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price beclomethasone 40 mcg/inh Inh Aer w/Adapt [INYO] 11174 CDM 59310-0202-12 NDC facility both 1 EA 738.67 738.67 Gross Charge Type: Pharmacy | NDC EA = 8.7 INH beclomethasone Nasal 0.042 mg/inh Spry [INYO] 11175 CDM 00173-0388-79 NDC facility both 1 EA 1408.12 1408.12 Gross Charge Type: Pharmacy | NDC EA = 25 SPRAYS phenytoin 125 mg/5 mL Oral Susp [INYO] 11180 CDM 51672-4069-01 NDC facility both 237 ML 184.85 184.85 Gross Charge Type: Pharmacy 85598-Lupus Anticoagulant Panel LC 11180112 CDM 300 RC 85598 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85598-Lupus Anticoagulant Panel LC 11180112 CDM 300 RC 85598 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85610-Lupus Anticoagulant Panel LC 11180113 CDM 300 RC 85610 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85610-Lupus Anticoagulant Panel LC 11180113 CDM 300 RC 85610 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85613-Lupus Anticoagulant Panel LC 11180115 CDM 300 RC 85613 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85613-Lupus Anticoagulant Panel LC 11180115 CDM 300 RC 85613 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85730-Lupus Anticoagulant Panel LC 11180116 CDM 300 RC 85730 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85730-Lupus Anticoagulant Panel LC 11180116 CDM 300 RC 85730 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85732-Lupus Anticoagulant Panel LC 11180117 CDM 300 RC 85732 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85732-Lupus Anticoagulant Panel LC 11180117 CDM 300 RC 85732 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 86147-Lupus Anticoagulant Panel LC 11180118 CDM 300 RC 86147 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 86147-Lupus Anticoagulant Panel LC 11180118 CDM 300 RC 86147 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price phenytoin 100 mg ERCap [INYO] 11184 CDM 00904-6187-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP gentamicin 20 mg/2 mL Inj Sol [INYO] 11185 CDM J1580 HCPCS 63323-0173-02 NDC facility both 2 ML 330 330 Gross Charge Type: Pharmacy 85670-Lupus Anticoagulant Panel LC 11185130 CDM 300 RC 85670 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 85670-Lupus Anticoagulant Panel LC 11185130 CDM 300 RC 85670 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 86146-Lupus Anticoagulant Panel LC 11185131 CDM 300 RC 86146 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price 86146-Lupus Anticoagulant Panel LC 11185131 CDM 300 RC 86146 HCPCS facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price phytonadione 1 mg/0.5 mL Inj Sol [INYO] 11189 CDM J3430 HCPCS 76329-1240-01 NDC facility both 0.5 ML 235 235 Gross Charge Type: Pharmacy Eosinophil Count LC 005298 11199444 CDM 300 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Eosinophil Count LC 005298 11199444 CDM 300 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price "11201 Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions" 11201 CDM 521 RC 11201 HCPCS facility both 34 34 Gross Charge Type: NIHD_RHC_Price "11201 Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions" 11201 CDM 521 RC 11201 HCPCS facility both 34 34 Gross Charge Type: NIHD_Clinic_Price Monitor Screen 13 Drug Class Profile (MedWatch) LC 733690 11201493 CDM 300 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price Monitor Screen 13 Drug Class Profile (MedWatch) LC 733690 11201493 CDM 300 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price "Dockweed, Yellow LC 602974" 11211929 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Dockweed, Yellow LC 602974" 11211929 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Ash, White LC 602927" 11212849 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Ash, White LC 602927" 11212849 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "83519-AChR Antibodies, Complete Profile LC" 11241636 CDM 301 RC 83519 HCPCS facility both 30.33 30.33 Gross Charge Type: NIHD_Hosp_Profee_Price "83519-AChR Antibodies, Complete Profile LC" 11241636 CDM 301 RC 83519 HCPCS facility both 30.33 30.33 Gross Charge Type: NIHD_Hosp_Profee_Price "Hemoglobin (Hb) A2, Quantitative LC 121060" 11241644 CDM 301 RC facility both 9.16 9.16 Gross Charge Type: NIHD_Hosp_Profee_Price "Hemoglobin (Hb) A2, Quantitative LC 121060" 11241644 CDM 301 RC facility both 9.16 9.16 Gross Charge Type: NIHD_Hosp_Profee_Price 86003 Aspergillus IgE Panel LC 819248 11243471 CDM 300 RC 86003 HCPCS facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 86003 Aspergillus IgE Panel LC 819248 11243471 CDM 300 RC 86003 HCPCS facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price amantadine 100 mg Cap [INYO] 11247 CDM 00904-7042-06 NDC facility both 1 EA 10.1 10.1 Gross Charge Type: Pharmacy | NDC EA = 1 CAP amantadine 100 mg Cap [INYO] 11247 CDM 00904-6630-61 NDC facility both 1 EA 12.91 12.91 Gross Charge Type: Pharmacy | NDC EA = 1 CAP amantadine 100 mg Cap [INYO] 11247 CDM 00904-6630-06 NDC facility both 1 EA 10.1 10.1 Gross Charge Type: Pharmacy | NDC EA = 1 CAP amantadine 100 mg Cap [INYO] 11247 CDM 50268-0069-15 NDC facility both 1 EA 20.9 20.9 Gross Charge Type: Pharmacy | NDC EA = 1 CAP amantadine 100 mg Cap [INYO] 11247 CDM 68084-0611-01 NDC facility both 1 EA 12.7 12.7 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Aspergillus IgE Panel LC 819248 11251238 CDM 300 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price Aspergillus IgE Panel LC 819248 11251238 CDM 300 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price "a-Thalassemia, DNA Analysis LC 511172" 11268164 CDM 300 RC facility both 285.08 285.08 Gross Charge Type: NIHD_Hosp_Profee_Price "a-Thalassemia, DNA Analysis LC 511172" 11268164 CDM 300 RC facility both 285.08 285.08 Gross Charge Type: NIHD_Hosp_Profee_Price "Buprenorphine, Screen Only, Urine LC 761160" 11268169 CDM 300 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price "Buprenorphine, Screen Only, Urine LC 761160" 11268169 CDM 300 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile With Total IgE, Respiratory Area 12 LC 603719" 11268171 CDM 300 RC facility both 3.06 3.06 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile With Total IgE, Respiratory Area 12 LC 603719" 11268171 CDM 300 RC facility both 3.06 3.06 Gross Charge Type: NIHD_Hosp_Profee_Price "86003-Allergen Profile With Total IgE, Respiratory Area 12 LC 603719" 11268200 CDM 300 RC 86003 HCPCS facility both 3.17 3.17 Gross Charge Type: NIHD_Hosp_Profee_Price "86003-Allergen Profile With Total IgE, Respiratory Area 12 LC 603719" 11268200 CDM 300 RC 86003 HCPCS facility both 3.17 3.17 Gross Charge Type: NIHD_Hosp_Profee_Price Chaetomium Globosum LC 602917 11268391 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Chaetomium Globosum LC 602917 11268391 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Common Silver Birch LC 602936 11272600 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Common Silver Birch LC 602936 11272600 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Plantain, English LC 602536" 11272605 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Plantain, English LC 602536" 11272605 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Eucalyptus LC 602930 11282485 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Eucalyptus LC 602930 11282485 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Macroprolactin LC 11283420 CDM 301 RC 84146 HCPCS facility both 36.25 36.25 Gross Charge Type: NIHD_Hosp_Profee_Price Macroprolactin LC 11283420 CDM 301 RC 84146 HCPCS facility both 36.25 36.25 Gross Charge Type: NIHD_Hosp_Profee_Price Asparagus LC 11285328 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Asparagus LC 11285328 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price 85014 11285517 CDM 301 RC 85014 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price 85014 11285517 CDM 301 RC 85014 HCPCS facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "84165 Protein Electrophoresis with Interpretation, Serum with Reflex to IFE, Serum LC" 11288022 CDM 301 RC 84165 HCPCS facility both 3.98 3.98 Gross Charge Type: NIHD_Hosp_Profee_Price "84165 Protein Electrophoresis with Interpretation, Serum with Reflex to IFE, Serum LC" 11288022 CDM 301 RC 84165 HCPCS facility both 3.98 3.98 Gross Charge Type: NIHD_Hosp_Profee_Price GI Enteric Pathogen Panel LC 11288590 CDM 301 RC facility both 408.5 408.5 Gross Charge Type: NIHD_Hosp_Profee_Price GI Enteric Pathogen Panel LC 11288590 CDM 301 RC facility both 408.5 408.5 Gross Charge Type: NIHD_Hosp_Profee_Price lidocaine Top 4% Sol [INYO] 11292 CDM 00527-6004-80 NDC facility both 1 EA 260 260 Gross Charge Type: Pharmacy | NDC EA = 50 APP lidocaine Top 4% Sol [INYO] 11292 CDM 00054-3505-47 NDC facility both 1 EA 240 240 Gross Charge Type: Pharmacy | NDC EA = 50 APP lidocaine Top 4% Sol [INYO] 11292 CDM 60432-0465-51 NDC facility both 1 EA 240 240 Gross Charge Type: Pharmacy | NDC EA = 50 APP lidocaine Top 4% Sol [INYO] 11292 CDM 52565-0009-50 NDC facility both 1 EA 260 260 Gross Charge Type: Pharmacy | NDC EA = 50 APP polyethylene glycol 3350 with electrolytes - Pow [INYO] 11298 CDM 43386-0090-19 NDC facility both 4000 ML 105.6 105.6 Gross Charge Type: Pharmacy polyethylene glycol 3350 with electrolytes Oral Pwdr for Sol 4000 mL [INYO] 11298 CDM 52268-0100-01 NDC facility both 4000 ML 115 115 Gross Charge Type: Pharmacy "11300 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion < 0.5cm" 11300 CDM 521 RC 11300 HCPCS facility both 367 367 Gross Charge Type: NIHD_RHC_Price "11300 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion < 0.5cm" 11300 CDM 521 RC 11300 HCPCS facility both 367 367 Gross Charge Type: NIHD_Clinic_Price "11301 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion 0.6 to 1.0cm" 11301 CDM 521 RC 11301 HCPCS facility both 467 467 Gross Charge Type: NIHD_RHC_Price "11301 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion 0.6 to 1.0cm" 11301 CDM 521 RC 11301 HCPCS facility both 467 467 Gross Charge Type: NIHD_Clinic_Price "11302 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion 1.1 to 2.0cm" 11302 CDM 521 RC 11302 HCPCS facility both 533 533 Gross Charge Type: NIHD_RHC_Price "11302 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion 1.1 to 2.0cm" 11302 CDM 521 RC 11302 HCPCS facility both 533 533 Gross Charge Type: NIHD_Clinic_Price "11303 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion >2.0cm" 11303 CDM 521 RC 11303 HCPCS facility both 582 582 Gross Charge Type: NIHD_RHC_Price "11303 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion >2.0cm" 11303 CDM 521 RC 11303 HCPCS facility both 582 582 Gross Charge Type: NIHD_Clinic_Price "11305 Shaving of epidermal or dermal lesion; scalp, neck, hands, feet, genitalia; > 0.5cm" 11305 CDM 521 RC 11305 HCPCS facility both 367 367 Gross Charge Type: NIHD_RHC_Price clarithromycin 250 mg/5 mL Oral Liq [INYO] 11305 CDM 00781-6023-52 NDC facility both 50 ML 428.6 428.6 Gross Charge Type: Pharmacy "84403 - Testosterone, Free/Tot Equilib LC" 11305974 CDM 301 RC 84403 HCPCS facility both 26.78 26.78 Gross Charge Type: NIHD_Hosp_Profee_Price "84403 - Testosterone, Free/Tot Equilib LC" 11305974 CDM 301 RC 84403 HCPCS facility both 26.78 26.78 Gross Charge Type: NIHD_Hosp_Profee_Price "11306 Shaving of epidermal or dermal lesion; scalp, neck, hands, feet, genitalia; 0.6-1.0cm" 11306 CDM 521 RC 11306 HCPCS facility both 467 467 Gross Charge Type: NIHD_RHC_Price "11306 Shaving of epidermal or dermal lesion; scalp, neck, hands, feet, genitalia; 0.6-1.0cm" 11306 CDM 521 RC 11306 HCPCS facility both 467 467 Gross Charge Type: NIHD_Clinic_Price "11307 Shaving of epidermal or dermal lesion; scalp, neck, hands, feet, genitalia; 1.1-2.0cm" 11307 CDM 521 RC 11307 HCPCS facility both 533 533 Gross Charge Type: NIHD_RHC_Price "11307 Shaving of epidermal or dermal lesion; scalp, neck, hands, feet, genitalia; 1.1-2.0cm" 11307 CDM 521 RC 11307 HCPCS facility both 263 263 Gross Charge Type: NIHD_Clinic_Price clotrimazole Top 1% Crm [INYO] 11309 CDM 00536-1272-11 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 15 APP clotrimazole Top 1% Crm [INYO] 11309 CDM 51672-1275-01 NDC facility both 1 EA 99.7 99.7 Gross Charge Type: Pharmacy | NDC EA = 15 APP clotrimazole Top 1% Crm [INYO] 11309 CDM 00904-7822-36 NDC facility both 1 EA 26.45 26.45 Gross Charge Type: Pharmacy | NDC EA = 15 APP "11310 Shaving of lesion; face, ears, eyelids, nose, lips, mucous membrane; < 0.5cm" 11310 CDM 521 RC 11310 HCPCS facility both 367 367 Gross Charge Type: NIHD_RHC_Price "11310 Shaving of lesion; face, ears, eyelids, nose, lips, mucous membrane; < 0.5cm" 11310 CDM 521 RC 11310 HCPCS facility both 352 352 Gross Charge Type: NIHD_Clinic_Price "11311 Shaving of lesion; face, ears, eyelids, nose, lips, mucous membrane; 0.6-1.0cm" 11311 CDM 521 RC 11311 HCPCS facility both 467 467 Gross Charge Type: NIHD_RHC_Price "11311 Shaving of lesion; face, ears, eyelids, nose, lips, mucous membrane; 0.6-1.0cm" 11311 CDM 521 RC 11311 HCPCS facility both 467 467 Gross Charge Type: NIHD_Clinic_Price "11312 Shaving of lesion; face, ears, eyelids, nose, lips, mucous membrane; 1.1-2.0cm" 11312 CDM 521 RC 11312 HCPCS facility both 533 533 Gross Charge Type: NIHD_RHC_Price "11312 Shaving of lesion; face, ears, eyelids, nose, lips, mucous membrane; 1.1-2.0cm" 11312 CDM 521 RC 11312 HCPCS facility both 533 533 Gross Charge Type: NIHD_Clinic_Price guaiFENesin 600 mg ER Tab [INYO] 11322 CDM 00904-6718-39 NDC facility both 1 EA 6.41 6.41 Gross Charge Type: Pharmacy | NDC EA = 1 TAB guaiFENesin 600 mg ER Tab [INYO] 11322 CDM 68084-0572-01 NDC facility both 1 EA 6.01 6.01 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "83018 Chromium and Cobalt, Whole Blood LC" 11340037 CDM 301 RC 83018 HCPCS facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "83018 Chromium and Cobalt, Whole Blood LC" 11340037 CDM 301 RC 83018 HCPCS facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "Estrogens, Total Serum LC 504796" 11343292 CDM 301 RC facility both 21.95 21.95 Gross Charge Type: NIHD_Hosp_Profee_Price "Estrogens, Total Serum LC 504796" 11343292 CDM 301 RC facility both 21.95 21.95 Gross Charge Type: NIHD_Hosp_Profee_Price Inheritest 14-gene Panel LC 11345139 CDM 300 RC facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81200 Inheritest 14-gene Panel LC 11345139_81200 CDM 300 RC 81200 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81209 Inheritest 14-gene Panel LC 11345139_81209 CDM 300 RC 81209 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81220 Inheritest 14-gene Panel LC 11345139_81220 CDM 300 RC 81220 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81242 Inheritest 14-gene Panel LC 11345139_81242 CDM 300 RC 81242 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81243 Inheritest 14-gene Panel LC 11345139_81243 CDM 300 RC 81243 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81251 Inheritest 14-gene Panel LC 11345139_81251 CDM 300 RC 81251 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81255 Inheritest 14-gene Panel LC 11345139_81255 CDM 300 RC 81255 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81260 Inheritest 14-gene Panel LC 11345139_81260 CDM 300 RC 81260 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81290 Inheritest 14-gene Panel LC 11345139_81290 CDM 300 RC 81290 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81329 Inheritest 14-gene Panel LC 11345139_81329 CDM 300 RC 81329 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81330 Inheritest 14-gene Panel LC 11345139_81330 CDM 300 RC 81330 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81361 Inheritest 14-gene Panel LC 11345139_81361 CDM 300 RC 81361 HCPCS facility both 25.77 25.77 Gross Charge Type: NIHD_Hosp_Profee_Price 81363 Inheritest 14-gene Panel LC 11345139_81363 CDM 300 RC 81363 HCPCS facility both 25.76 25.76 Gross Charge Type: NIHD_Hosp_Profee_Price 81363 Inheritest 14-gene Panel LC 11345139_81363 CDM 300 RC 81363 HCPCS facility both 25.76 25.76 Gross Charge Type: NIHD_Hosp_Profee_Price RING PESSARY INCONTINENCE #2 1135112 CDM facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price RING PESSARY INCONTINENCE #2 1135112 CDM facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price "87206-M tuberculusis PCR, AFB Smear and Culture LC" 11375663 CDM 300 RC 87206 HCPCS facility both 91.32 91.32 Gross Charge Type: NIHD_Hosp_Profee_Price "87206-M tuberculusis PCR, AFB Smear and Culture LC" 11375663 CDM 300 RC 87206 HCPCS facility both 91.32 91.32 Gross Charge Type: NIHD_Hosp_Profee_Price "87556-M tuberculusis PCR, AFB Smear and Culture LC" 11375664 CDM 300 RC 87556 HCPCS facility both 91.38 91.38 Gross Charge Type: NIHD_Hosp_Profee_Price "87556-M tuberculusis PCR, AFB Smear and Culture LC" 11375664 CDM 300 RC 87556 HCPCS facility both 91.38 91.38 Gross Charge Type: NIHD_Hosp_Profee_Price "Ustekinumab and Anti-Ustekinumab Antibody, DoseASSURE UST LC 504594" 11387230 CDM 301 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price "Ustekinumab and Anti-Ustekinumab Antibody, DoseASSURE UST LC 504594" 11387230 CDM 301 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price "M tuberculosis PCR, AFB Smear and Culture LC" 11387314 CDM 300 RC facility both 91.32 91.32 Gross Charge Type: NIHD_Hosp_Profee_Price "M tuberculosis PCR, AFB Smear and Culture LC" 11387314 CDM 300 RC facility both 91.32 91.32 Gross Charge Type: NIHD_Hosp_Profee_Price "87798-M tuberculusis PCR, AFB Smear and Culture LC" 11387805 CDM 300 RC 87798 HCPCS facility both 91.32 91.32 Gross Charge Type: NIHD_Hosp_Profee_Price "87798-M tuberculusis PCR, AFB Smear and Culture LC" 11387805 CDM 300 RC 87798 HCPCS facility both 91.32 91.32 Gross Charge Type: NIHD_Hosp_Profee_Price azithromycin 250 mg Tab 11396 CDM 00904-7350-06 NDC facility both 1 EA 8.89 8.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB azithromycin 250 mg Tab [INYO] 11396 CDM 50268-0074-15 NDC facility both 1 EA 8.89 8.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB azithromycin 250 mg Tab [INYO] 11396 CDM 60687-0742-65 NDC facility both 1 EA 11.23 11.23 Gross Charge Type: Pharmacy | NDC EA = 1 TAB azithromycin 250 mg Tab [INYO] 11396 CDM 00904-6708-06 NDC facility both 1 EA 8.89 8.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB azithromycin 250 mg Tab [INYO] 11396 CDM 00904-6405-06 NDC facility both 1 EA 17.55 17.55 Gross Charge Type: Pharmacy | NDC EA = 1 TAB azithromycin 200 mg/5 mL Oral Liq [INYO] 11397 CDM Q0144 HCPCS 42806-0150-33 NDC facility both 22.5 ML 174.4 174.4 Gross Charge Type: Pharmacy azithromycin 200 mg/5 mL Oral Liq [INYO] 11397 CDM Q0144 HCPCS 00093-2026-94 NDC facility both 22.5 ML 174.4 174.4 Gross Charge Type: Pharmacy "11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm" 114001 CDM 521 RC 11400 HCPCS facility both 227 227 Gross Charge Type: NIHD_RHC_Price "11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm" 114001 CDM 521 RC 11400 HCPCS facility both 227 227 Gross Charge Type: NIHD_Clinic_Price "11400 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114002 CDM 982 RC 11400 HCPCS facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price "11400 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114002 CDM 982 RC 11400 HCPCS facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price "11401 Excision, benign lesion including margins; trunk, arms or legs; 0.6-1.0cm" 114011 CDM 521 RC 11401 HCPCS facility both 274 274 Gross Charge Type: NIHD_RHC_Price "11401 Excision, benign lesion including margins; trunk, arms or legs; 0.6-1.0cm" 114011 CDM 521 RC 11401 HCPCS facility both 274 274 Gross Charge Type: NIHD_Clinic_Price "11401 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114012 CDM 982 RC 11401 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price "11401 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114012 CDM 982 RC 11401 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price "Porphyrins, Total Serum LC" 11401257 CDM 301 RC facility both 46.85 46.85 Gross Charge Type: NIHD_Hosp_Profee_Price "Porphyrins, Total Serum LC" 11401257 CDM 301 RC facility both 46.85 46.85 Gross Charge Type: NIHD_Hosp_Profee_Price "11402 Excision, benign lesion including margins; trunk, arms or legs; 1.1-2.0cm" 114021 CDM 521 RC 11402 HCPCS facility both 304 304 Gross Charge Type: NIHD_RHC_Price "11402 Excision, benign lesion including margins; trunk, arms or legs; 1.1-2.0cm" 114021 CDM 521 RC 11402 HCPCS facility both 304 304 Gross Charge Type: NIHD_Clinic_Price "11402 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114022 CDM 982 RC 11402 HCPCS facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price "11402 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114022 CDM 982 RC 11402 HCPCS facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price "11403 Excision, benign lesion including margins; trunk, arms or legs; 2.1-3.0cm" 114031 CDM 521 RC 11403 HCPCS facility both 349 349 Gross Charge Type: NIHD_RHC_Price "11403 Excision, benign lesion including margins; trunk, arms or legs; 2.1-3.0cm" 114031 CDM 521 RC 11403 HCPCS facility both 624 624 Gross Charge Type: NIHD_Clinic_Price "11403 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114032 CDM 982 RC 11403 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price "11403 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114032 CDM 982 RC 11403 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price "11404 Excision, benign lesion including margins; trunk, arms or legs; 3.1-4.0cm" 114041 CDM 521 RC 11404 HCPCS facility both 396 396 Gross Charge Type: NIHD_RHC_Price "11404 Excision, benign lesion including margins; trunk, arms or legs; 3.1-4.0cm" 114041 CDM 521 RC 11404 HCPCS facility both 396 396 Gross Charge Type: NIHD_Clinic_Price "11404 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114042 CDM 982 RC 11404 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price "11404 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114042 CDM 982 RC 11404 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price "11406 Excision, benign lesion including margins; trunk, arms or legs; >4.0cm" 114061 CDM 521 RC 11406 HCPCS facility both 559 559 Gross Charge Type: NIHD_RHC_Price "11406 Excision, benign lesion including margins; trunk, arms or legs; >4.0cm" 114061 CDM 521 RC 11406 HCPCS facility both 559 559 Gross Charge Type: NIHD_Clinic_Price "11406 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114062 CDM 982 RC 11406 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "11406 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114062 CDM 982 RC 11406 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price amphotericin B 50 mg IV Inj [INYO] 11412 CDM J0285 HCPCS 39822-1055-05 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy EXC BNGN LES S/N/H/F/G 0.5 CM/< 114201 CDM 521 RC 11420 HCPCS facility both 229 229 Gross Charge Type: NIHD_RHC_Price EXC BNGN LES S/N/H/F/G 0.5 CM/< 114201 CDM 521 RC 11420 HCPCS facility both 229 229 Gross Charge Type: NIHD_Clinic_Price "11420 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114202 CDM 982 RC 11420 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price "11420 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114202 CDM 982 RC 11420 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price EXC BNGN LES S/N/H/F/G 0.6-1.0 114211 CDM 521 RC 11421 HCPCS facility both 286 286 Gross Charge Type: NIHD_RHC_Price EXC BNGN LES S/N/H/F/G 0.6-1.0 114211 CDM 521 RC 11421 HCPCS facility both 286 286 Gross Charge Type: NIHD_Clinic_Price "11421 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114212 CDM 982 RC 11421 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "11421 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114212 CDM 982 RC 11421 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "11422 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 1.1-2.0cm" 114221 CDM 521 RC 11422 HCPCS facility both 322 322 Gross Charge Type: NIHD_RHC_Price "11422 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 1.1-2.0cm" 114221 CDM 521 RC 11422 HCPCS facility both 322 322 Gross Charge Type: NIHD_Clinic_Price "11422 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114222 CDM 982 RC 11422 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "11422 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114222 CDM 982 RC 11422 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "11423 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 2.1-3.0cm" 114231 CDM 521 RC 11423 HCPCS facility both 363 363 Gross Charge Type: NIHD_RHC_Price "11423 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 2.1-3.0cm" 114231 CDM 521 RC 11423 HCPCS facility both 363 363 Gross Charge Type: NIHD_Clinic_Price "11423 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114232 CDM 982 RC 11423 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "11423 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114232 CDM 982 RC 11423 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "11424 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 3.1-4.0cm" 114241 CDM 521 RC 11424 HCPCS facility both 419 419 Gross Charge Type: NIHD_RHC_Price "11424 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; 3.1-4.0cm" 114241 CDM 521 RC 11424 HCPCS facility both 419 419 Gross Charge Type: NIHD_Clinic_Price "11424 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114242 CDM 982 RC 11424 HCPCS facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price "11424 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114242 CDM 982 RC 11424 HCPCS facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price "11426 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; > 4.0cm" 114261 CDM 521 RC 11426 HCPCS facility both 594 594 Gross Charge Type: NIHD_RHC_Price "11426 Excision, benign lesion including margins; scalp, neck, hands, feet, genitalia; > 4.0cm" 114261 CDM 521 RC 11426 HCPCS facility both 594 594 Gross Charge Type: NIHD_Clinic_Price "11426 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114262 CDM 982 RC 11426 HCPCS facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price "11426 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), ProFee" 114262 CDM 982 RC 11426 HCPCS facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price IAA+GAD 65 LC 11433189 CDM 301 RC facility both 242.25 242.25 Gross Charge Type: NIHD_Hosp_Profee_Price IAA+GAD 65 LC 11433189 CDM 301 RC facility both 242.25 242.25 Gross Charge Type: NIHD_Hosp_Profee_Price cyclobenzaprine 10 mg Tab [INYO] 11439 CDM 69097-0846-07 NDC facility both 1 EA 6.95 6.95 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cyclobenzaprine 10 mg Tab [INYO] 11439 CDM 60687-0558-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cyclobenzaprine 10 mg Tab [INYO] 11439 CDM 51079-0644-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "11440 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; < 0.5cm" 114401 CDM 521 RC 11440 HCPCS facility both 251 251 Gross Charge Type: NIHD_RHC_Price "11440 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; < 0.5cm" 114401 CDM 521 RC 11440 HCPCS facility both 251 251 Gross Charge Type: NIHD_Clinic_Price 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< TechFee 114402 CDM 450 RC facility both 1818 1818 Gross Charge Type: NIHD_Hosp_Profee_Price 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< TechFee 114402 CDM 450 RC facility both 1818 1818 Gross Charge Type: NIHD_Hosp_Profee_Price "11440 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114403 CDM 982 RC 11440 HCPCS facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price "11440 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114403 CDM 982 RC 11440 HCPCS facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price "11441 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; 0.6-1.0cm" 114411 CDM 521 RC 11441 HCPCS facility both 308 308 Gross Charge Type: NIHD_RHC_Price "11441 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; 0.6-1.0cm" 114411 CDM 521 RC 11441 HCPCS facility both 308 308 Gross Charge Type: NIHD_Clinic_Price "11441 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114412 CDM 982 RC 11441 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "11441 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114412 CDM 982 RC 11441 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price EXC BNGN LES S/N/H/F/G 1.1-2.0 114421 CDM 521 RC 11442 HCPCS facility both 341 341 Gross Charge Type: NIHD_RHC_Price EXC BNGN LES S/N/H/F/G 1.1-2.0 114421 CDM 521 RC 11442 HCPCS facility both 341 341 Gross Charge Type: NIHD_Clinic_Price "11442 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114422 CDM 982 RC 11442 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "11442 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114422 CDM 982 RC 11442 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "11443 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; 2.1-3.0cm" 114431 CDM 521 RC 11443 HCPCS facility both 403 403 Gross Charge Type: NIHD_RHC_Price "11443 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; 2.1-3.0cm" 114431 CDM 521 RC 11443 HCPCS facility both 403 403 Gross Charge Type: NIHD_Clinic_Price "11443 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114432 CDM 982 RC 11443 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "11443 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114432 CDM 982 RC 11443 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "11444 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; 3.1-4.0cm" 114441 CDM 521 RC 11444 HCPCS facility both 504 504 Gross Charge Type: NIHD_RHC_Price "11444 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; 3.1-4.0cm" 114441 CDM 521 RC 11444 HCPCS facility both 504 504 Gross Charge Type: NIHD_Clinic_Price "11444 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114442 CDM 982 RC 11444 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price "11444 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114442 CDM 982 RC 11444 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price "11446 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; > 4.0cm" 114461 CDM 521 RC 11446 HCPCS facility both 690 690 Gross Charge Type: NIHD_RHC_Price "11446 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; > 4.0cm" 114461 CDM 521 RC 11446 HCPCS facility both 690 690 Gross Charge Type: NIHD_Clinic_Price "11446 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114462 CDM 982 RC 11446 HCPCS facility both 569 569 Gross Charge Type: NIHD_Hosp_Profee_Price "11446 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWH ProFee" 114462 CDM 982 RC 11446 HCPCS facility both 569 569 Gross Charge Type: NIHD_Hosp_Profee_Price UA w Micro if Ind 1148022 CDM 307 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price UA w Micro if Ind 1148022 CDM 307 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price "2019 Novel Coronavirus (COVID-19), NAA using Saliva Collection LC 139945" 11527584 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price "2019 Novel Coronavirus (COVID-19), NAA using Saliva Collection LC 139945" 11527584 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Adenovirus (Type 40/41)/Rotavirus. Direct Detection EIA LC 11530235 CDM 301 RC facility both 22.4 22.4 Gross Charge Type: NIHD_Hosp_Profee_Price Adenovirus (Type 40/41)/Rotavirus. Direct Detection EIA LC 11530235 CDM 301 RC facility both 22.4 22.4 Gross Charge Type: NIHD_Hosp_Profee_Price Microsporidia Stain LC 11530296 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Microsporidia Stain LC 11530296 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price "Mesh: 3DMax Mesh, Left, Size XL, 5"" x 7""" 115312 CDM 278 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price "Mesh: 3DMax Mesh, Left, Size XL, 5"" x 7""" 115312 CDM 278 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price lovastatin 20 mg Tab [INYO] 11554 CDM 68180-0468-01 NDC facility both 1 EA 14.24 14.24 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lovastatin 20 mg Tab [INYO] 11554 CDM 63739-0281-10 NDC facility both 1 EA 17.43 17.43 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 1 mg Tab [INYO] 11555 CDM 00904-6008-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 1 mg Tab [INYO] 11555 CDM 60687-0638-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 1 mg Tab [INYO] 11555 CDM 51079-0386-20 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 1 mg Tab [INYO] 11555 CDM 63739-0500-10 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 1 mg Tab [INYO] 11555 CDM 69315-0905-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB loperamide 2 mg Cap [INYO] 11557 CDM 60687-0229-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP loperamide 2 mg Cap [INYO] 11557 CDM 51079-0690-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP APAP-codeine 120 mg-12 mg/5 mL Oral Liq 5 mL [INYO] 11576 CDM 00121-0504-05 NDC facility both 5 ML 35 35 Gross Charge Type: Pharmacy amikacin 250 mg/mL [INYO] 11592 CDM J0278 HCPCS 00703-9032-03 NDC facility both 2 ML 330 330 Gross Charge Type: Pharmacy amikacin 250 mg/mL [INYO] 11592 CDM J0278 HCPCS 23155-0290-41 NDC facility both 2 ML 330 330 Gross Charge Type: Pharmacy "11600 Excision, malignant lesion including margins, trunk, arms, or legs; < 0.5cm" 116001 CDM 521 RC 11600 HCPCS facility both 354 354 Gross Charge Type: NIHD_RHC_Price "11600 Excision, malignant lesion including margins, trunk, arms, or legs; < 0.5cm" 116001 CDM 521 RC 11600 HCPCS facility both 354 354 Gross Charge Type: NIHD_Clinic_Price "11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0 ProFee" 116002 CDM 982 RC 11600 HCPCS facility both 215 215 Gross Charge Type: NIHD_Hosp_Profee_Price "11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0 ProFee" 116002 CDM 982 RC 11600 HCPCS facility both 215 215 Gross Charge Type: NIHD_Hosp_Profee_Price "11601 Excision, malignant lesion including margins, trunk, arms, or legs; 0.6-1.0cm" 116011 CDM 521 RC 11601 HCPCS facility both 410 410 Gross Charge Type: NIHD_RHC_Price "11601 Excision, malignant lesion including margins, trunk, arms, or legs; 0.6-1.0cm" 116011 CDM 521 RC 11601 HCPCS facility both 410 410 Gross Charge Type: NIHD_Clinic_Price "11601 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0 ProFee" 116012 CDM 982 RC 11601 HCPCS facility both 263 263 Gross Charge Type: NIHD_Hosp_Profee_Price "11601 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0 ProFee" 116012 CDM 982 RC 11601 HCPCS facility both 263 263 Gross Charge Type: NIHD_Hosp_Profee_Price "11602 Excision, malignant lesion including margins, trunk, arms, or legs; 1.1-2.0cm" 116021 CDM 521 RC 11602 HCPCS facility both 442 442 Gross Charge Type: NIHD_RHC_Price "11602 Excision, malignant lesion including margins, trunk, arms, or legs; 1.1-2.0cm" 116021 CDM 521 RC 11602 HCPCS facility both 442 442 Gross Charge Type: NIHD_Clinic_Price "11602 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 1 ProFee" 116022 CDM 982 RC 11602 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "11602 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 1 ProFee" 116022 CDM 982 RC 11602 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "11603 Excision, malignant lesion including margins, trunk, arms, or legs; 2.1-3.0cm" 116031 CDM 521 RC 11603 HCPCS facility both 503 503 Gross Charge Type: NIHD_RHC_Price "11603 Excision, malignant lesion including margins, trunk, arms, or legs; 2.1-3.0cm" 116031 CDM 521 RC 11603 HCPCS facility both 503 503 Gross Charge Type: NIHD_Clinic_Price "11603 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 2 ProFee" 116032 CDM 982 RC 11603 HCPCS facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price "11603 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 2 ProFee" 116032 CDM 982 RC 11603 HCPCS facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price "11604 Excision, malignant lesion including margins, trunk, arms, or legs; 3.1-4.0cm" 116041 CDM 521 RC 11604 HCPCS facility both 558 558 Gross Charge Type: NIHD_RHC_Price "11604 Excision, malignant lesion including margins, trunk, arms, or legs; 3.1-4.0cm" 116041 CDM 521 RC 11604 HCPCS facility both 558 558 Gross Charge Type: NIHD_Clinic_Price "11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 3 ProFee" 116042 CDM 982 RC 11604 HCPCS facility both 376 376 Gross Charge Type: NIHD_Hosp_Profee_Price "11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 3 ProFee" 116042 CDM 982 RC 11604 HCPCS facility both 376 376 Gross Charge Type: NIHD_Hosp_Profee_Price "11606 Excision, malignant lesion including margins, trunk, arms, or legs; >4.0cm" 116061 CDM 521 RC 11606 HCPCS facility both 794 794 Gross Charge Type: NIHD_RHC_Price "11606 Excision, malignant lesion including margins, trunk, arms, or legs; >4.0cm" 116061 CDM 521 RC 11606 HCPCS facility both 794 794 Gross Charge Type: NIHD_Clinic_Price "11606 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER O ProFee" 116062 CDM 982 RC 11606 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "11606 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER O ProFee" 116062 CDM 982 RC 11606 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; < 0.5cm" 116201 CDM 521 RC 11620 HCPCS facility both 356 356 Gross Charge Type: NIHD_RHC_Price "11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; < 0.5cm" 116201 CDM 521 RC 11620 HCPCS facility both 356 356 Gross Charge Type: NIHD_Clinic_Price "11620 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116202 CDM 982 RC 11620 HCPCS facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price "11620 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116202 CDM 982 RC 11620 HCPCS facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price "11621 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 0.6-1.0cm" 116211 CDM 521 RC 11621 HCPCS facility both 413 413 Gross Charge Type: NIHD_RHC_Price "11621 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 0.6-1.0cm" 116211 CDM 521 RC 11621 HCPCS facility both 413 413 Gross Charge Type: NIHD_Clinic_Price "11621 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116212 CDM 982 RC 11621 HCPCS facility both 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price "11621 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116212 CDM 982 RC 11621 HCPCS facility both 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price "11622 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 1.1-2.0cm" 116221 CDM 521 RC 11622 HCPCS facility both 457 457 Gross Charge Type: NIHD_RHC_Price "11622 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 1.1-2.0cm" 116221 CDM 521 RC 11622 HCPCS facility both 457 457 Gross Charge Type: NIHD_Clinic_Price "11622 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116222 CDM 982 RC 11622 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price "11622 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116222 CDM 982 RC 11622 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price "11623 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 2.1-3.0cm" 116231 CDM 521 RC 11623 HCPCS facility both 534 534 Gross Charge Type: NIHD_RHC_Price "11623 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 2.1-3.0cm" 116231 CDM 521 RC 11623 HCPCS facility both 534 534 Gross Charge Type: NIHD_Clinic_Price "11623 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116232 CDM 982 RC 11623 HCPCS facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "11623 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116232 CDM 982 RC 11623 HCPCS facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "11624 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 3.1-4.0cm" 116241 CDM 521 RC 11624 HCPCS facility both 602 602 Gross Charge Type: NIHD_RHC_Price "11624 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; 3.1-4.0cm" 116241 CDM 521 RC 11624 HCPCS facility both 602 602 Gross Charge Type: NIHD_Clinic_Price "11624 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116242 CDM 982 RC 11624 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "11624 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116242 CDM 982 RC 11624 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "11626 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; >4.0cm" 116261 CDM 521 RC 11626 HCPCS facility both 723 723 Gross Charge Type: NIHD_RHC_Price "11626 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; >4.0cm" 116261 CDM 521 RC 11626 HCPCS facility both 723 723 Gross Charge Type: NIHD_Clinic_Price "11626 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116262 CDM 982 RC 11626 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price "11626 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXC ProFee" 116262 CDM 982 RC 11626 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price "11640 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 0.5 cm" 116401 CDM 521 RC 11640 HCPCS facility both 365 365 Gross Charge Type: NIHD_RHC_Price "11640 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 0.5 cm" 116401 CDM 521 RC 11640 HCPCS facility both 365 365 Gross Charge Type: NIHD_Clinic_Price "11640 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116402 CDM 982 RC 11640 HCPCS facility both 222 222 Gross Charge Type: NIHD_Hosp_Profee_Price "11640 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116402 CDM 982 RC 11640 HCPCS facility both 222 222 Gross Charge Type: NIHD_Hosp_Profee_Price "11641 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 0.6-1.0cm" 116411 CDM 521 RC 11641 HCPCS facility both 426 426 Gross Charge Type: NIHD_RHC_Price "11641 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 0.6-1.0cm" 116411 CDM 521 RC 11641 HCPCS facility both 426 426 Gross Charge Type: NIHD_Clinic_Price "11641 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116412 CDM 982 RC 11641 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "11641 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116412 CDM 982 RC 11641 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "11642 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 1.1-2.0cm" 116421 CDM 521 RC 11642 HCPCS facility both 484 484 Gross Charge Type: NIHD_RHC_Price "11642 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 1.1-2.0cm" 116421 CDM 521 RC 11642 HCPCS facility both 484 484 Gross Charge Type: NIHD_Clinic_Price "11642 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116422 CDM 982 RC 11642 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "11642 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116422 CDM 982 RC 11642 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "11643 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 2.1-3.0cm" 116431 CDM 521 RC 11643 HCPCS facility both 566 566 Gross Charge Type: NIHD_RHC_Price "11643 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 2.1-3.0cm" 116431 CDM 521 RC 11643 HCPCS facility both 566 566 Gross Charge Type: NIHD_Clinic_Price "11643 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116432 CDM 982 RC 11643 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "11643 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116432 CDM 982 RC 11643 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "11644 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 3.1-4.0cm" 116441 CDM 521 RC 11644 HCPCS facility both 696 696 Gross Charge Type: NIHD_RHC_Price "11644 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; 3.1-4.0cm" 116441 CDM 521 RC 11644 HCPCS facility both 696 696 Gross Charge Type: NIHD_Clinic_Price "11644 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116442 CDM 982 RC 11644 HCPCS facility both 500 500 Gross Charge Type: NIHD_Hosp_Profee_Price "11644 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116442 CDM 982 RC 11644 HCPCS facility both 500 500 Gross Charge Type: NIHD_Hosp_Profee_Price "11646 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 4.0 cm" 116461 CDM 521 RC 11646 HCPCS facility both 902 902 Gross Charge Type: NIHD_RHC_Price "11646 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; < 4.0 cm" 116461 CDM 521 RC 11646 HCPCS facility both 902 902 Gross Charge Type: NIHD_Clinic_Price "11646 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116462 CDM 982 RC 11646 HCPCS facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price "11646 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED ProFee" 116462 CDM 982 RC 11646 HCPCS facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price benzocaine-menthol topical 6 mg-10 mg Loz [INYO] 11671 CDM 78112-0011-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 LOZENGES "Ophth irrigation, extraocular Sol [INYO]" 11703 CDM 00065-0530-04 NDC facility both 1 EA 201.6 201.6 Gross Charge Type: Pharmacy | NDC EA = 120 DROPS "Ophth irrigation, extraocular Sol [INYO]" 11703 CDM 00536-1224-97 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 120 DROPS "Ophth irrigation, extraocular Sol [INYO]" 11703 CDM 10119-0002-52 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 120 DROPS propofol 200 mg/20 mL IV Emul [INYO] 11705 CDM J2704 HCPCS 63323-0269-29 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy propofol 200 mg/20 mL IV Emul [INYO] 11705 CDM J2704 HCPCS 00409-4699-30 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy propofol 200 mg/20mL IV Emul [INYO] 11705 CDM J2704 HCPCS 00069-0209-10 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy propofol 200 mg/20 mL IV Emul [INYO] 11705 CDM J2704 HCPCS 63323-0269-70 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy propofol 200 mg/20 mL IV Emul [INYO] 11705 CDM J2704 HCPCS 25021-0608-20 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy propofol 500 mg/50 mL IV Emul 50 mL [INYO] 11707 CDM J2704 HCPCS 63323-0269-50 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy propofol 500 mg/50 mL IV Emul 50 mL [INYO] 11707 CDM J2704 HCPCS 00409-4699-33 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy propofol 500 mg/50 mL IV Emul 50 mL [INYO] 11707 CDM J2704 HCPCS 63323-0269-77 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy propofol 500 mg/50 mL IV Emul 50 mL [INYO] 11707 CDM J2704 HCPCS 43598-0548-21 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy propofol 500 mg/50 mL IV Emul 50 mL [INYO] 11707 CDM J2704 HCPCS 25021-0608-50 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy TRIM NONDYSTRPHC NAIL ANY NMBR 11719 CDM 521 RC 11719 HCPCS facility both 66 66 Gross Charge Type: NIHD_RHC_Price TRIM NONDYSTRPHC NAIL ANY NMBR 11719 CDM 521 RC 11719 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price 11720 Debridement of nail(s) by any method(s); 1 to 5 11720 CDM 521 RC 11720 HCPCS facility both 60 60 Gross Charge Type: NIHD_RHC_Price 11720 Debridement of nail(s) by any method(s); 1 to 5 11720 CDM 521 RC 11720 HCPCS facility both 60 60 Gross Charge Type: NIHD_Clinic_Price 11720 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 1 TO 5 ProFee 11720 CDM 982 RC 11720 HCPCS facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 11720 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 1 TO 5 ProFee 11720 CDM 982 RC 11720 HCPCS facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 11720 DEBRIDEMENT NAIL ANY METHOD 1-5 TechFee 117202 CDM 450 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price 11720 DEBRIDEMENT NAIL ANY METHOD 1-5 TechFee 117202 CDM 450 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price 11721 Debridement of nail(s) by any method(s); 6 or more 11721 CDM 521 RC 11721 HCPCS facility both 80 80 Gross Charge Type: NIHD_RHC_Price 11721 Debridement of nail(s) by any method(s); 6 or more 11721 CDM 521 RC 11721 HCPCS facility both 80 80 Gross Charge Type: NIHD_Clinic_Price "11730 Avulsion of nail plate, partial or complete, simple; single" 117301 CDM 521 RC 11730 HCPCS facility both 291 291 Gross Charge Type: NIHD_RHC_Price "11730 Avulsion of nail plate, partial or complete, simple; single" 117301 CDM 521 RC 11730 HCPCS facility both 282 282 Gross Charge Type: NIHD_Clinic_Price 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee 117302 CDM 450 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee 117302 CDM 450 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "11730 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE ProFee" 117303 CDM 982 RC 11730 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price "11730 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE ProFee" 117303 CDM 982 RC 11730 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price "11732 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH AD TechFee" 11732 CDM 450 RC facility both 152 152 Gross Charge Type: NIHD_Hosp_Profee_Price "11732 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH AD TechFee" 11732 CDM 450 RC facility both 152 152 Gross Charge Type: NIHD_Hosp_Profee_Price "11732 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH AD ProFee" 117321 CDM 11732 HCPCS facility both 26 26 Gross Charge Type: NIHD_Hosp_Profee_Price "11732 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH AD ProFee" 117321 CDM 11732 HCPCS facility both 26 26 Gross Charge Type: NIHD_Hosp_Profee_Price "11732 Avulsion of nail plate, partial or complete, simple; each additional nail plate" 117322 CDM 521 RC 11732 HCPCS facility both 52 52 Gross Charge Type: NIHD_RHC_Price "11732 Avulsion of nail plate, partial or complete, simple; each additional nail plate" 117322 CDM 521 RC 11732 HCPCS facility both 52 52 Gross Charge Type: NIHD_Clinic_Price 11740 Evacuation of subungual hematoma 117401 CDM 521 RC 11740 HCPCS facility both 123 123 Gross Charge Type: NIHD_RHC_Price 11740 Evacuation of subungual hematoma 117401 CDM 521 RC 11740 HCPCS facility both 123 123 Gross Charge Type: NIHD_Clinic_Price 11740 EVACUATION SUBUNGUAL HEMATOMA TechFee 117402 CDM 450 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 11740 EVACUATION SUBUNGUAL HEMATOMA TechFee 117402 CDM 450 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Drainage Nail Bed Charge 117403 CDM 761 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Drainage Nail Bed Charge 117403 CDM 761 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 11740 EVACUATION OF SUBUNGUAL HEMATOMA ProFee 117404 CDM 982 RC 11740 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 11740 EVACUATION OF SUBUNGUAL HEMATOMA ProFee 117404 CDM 982 RC 11740 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price EXC NAIL MTRIX PERM RMVL 117501 CDM 521 RC 11750 HCPCS facility both 998 998 Gross Charge Type: NIHD_RHC_Price 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee 117502 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee 117502 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price "11750 EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE (EG, INGROWN OR DEFORMED NAIL), ProFee" 117503 CDM 982 RC 11750 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "11750 EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE (EG, INGROWN OR DEFORMED NAIL), ProFee" 117503 CDM 982 RC 11750 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price CF Full-gene Carrier Screen LC 11751683 CDM 301 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price CF Full-gene Carrier Screen LC 11751683 CDM 301 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 11760 REPAIR NAIL BED TechFee 117601 CDM 450 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 11760 REPAIR NAIL BED TechFee 117601 CDM 450 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 11760 REPAIR OF NAIL BED ProFee 117602 CDM 982 RC 11760 HCPCS facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 11760 REPAIR OF NAIL BED ProFee 117602 CDM 982 RC 11760 HCPCS facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 11765 WEDGE EXCISION SKIN NAIL FOLD TechFee 117651 CDM 450 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 11765 WEDGE EXCISION SKIN NAIL FOLD TechFee 117651 CDM 450 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price "11765 WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWN TOENAIL) ProFee" 117652 CDM 982 RC 11765 HCPCS facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price "11765 WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWN TOENAIL) ProFee" 117652 CDM 982 RC 11765 HCPCS facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price ATN Profile LC 11768897 CDM 301 RC facility both 134.5 134.5 Gross Charge Type: NIHD_Hosp_Profee_Price ATN Profile LC 11768897 CDM 301 RC facility both 134.5 134.5 Gross Charge Type: NIHD_Hosp_Profee_Price 83520-ATN Profile LC 11769773 CDM 301 RC 83520 HCPCS facility both 134.5 134.5 Gross Charge Type: NIHD_Hosp_Profee_Price 83520-ATN Profile LC 11769773 CDM 301 RC 83520 HCPCS facility both 134.5 134.5 Gross Charge Type: NIHD_Hosp_Profee_Price 11770 Excision of pilonidal cyst or sinus; simple 117701 CDM 521 RC 11770 HCPCS facility both 375 375 Gross Charge Type: NIHD_Clinic_Price 11770 EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE ProFee 117702 CDM 982 RC 11770 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 11770 EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE ProFee 117702 CDM 982 RC 11770 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 11771 Excision of pilonidal cyst or sinus; extensive 117711 CDM 521 RC 11771 HCPCS facility both 201 201 Gross Charge Type: NIHD_Clinic_Price 11771 EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE ProFee 117712 CDM 982 RC 11771 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price 11771 EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE ProFee 117712 CDM 982 RC 11771 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price 11772 Excision of pilonidal cyst or sinus; complicated 117721 CDM 521 RC 11772 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Clinic_Price 11772 EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED ProFee 117722 CDM 982 RC 11772 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price 11772 EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED ProFee 117722 CDM 982 RC 11772 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price hyaluronidase human recombinant 150 units/mL [INYO] 11793 CDM J3473 HCPCS 18657-0117-04 NDC facility both 1 EA 535.68 535.68 Gross Charge Type: Pharmacy conjugated estrogens 0.625 mg Tab [INYO] 11797 CDM 00046-1102-81 NDC facility both 1 EA 42.51 42.51 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dilTIAZem 30 mg Tab [INYO] 11799 CDM 60687-0717-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB diltiazem 30 mg Tab [INYO] 11799 CDM 00093-0318-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB diltiazem 30 mg Tab [INYO] 11799 CDM 60687-0562-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB docusate sodium 100 mg Cap [INYO] 11801 CDM 63739-0478-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP docusate sodium 100 mg Cap [INYO] 11801 CDM 00904-7183-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP docusate sodium 100 mg Cap [INYO] 11801 CDM 00904-6455-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP docusate sodium 100 mg Cap [INYO] 11801 CDM 63739-0478-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP fentaNYL 50 mcg/hr Fil [INYO] 11804 CDM 47781-0426-47 NDC facility both 1 EA 194.41 194.41 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES fentaNYL 50 mcg/hr Transderm ER Film [INYO] 11804 CDM 00406-9050-76 NDC facility both 1 EA 131.8 131.8 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES fentaNYL 50 mcg/hr Transderm ER Film [INYO] 11804 CDM 60505-7082-02 NDC facility both 1 EA 194.41 194.41 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES fentaNYL 25 mcg/hr Transderm ER Film [INYO] 11805 CDM 00406-9025-76 NDC facility both 1 EA 72.1 72.1 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES fentaNYL 25 mcg/hr Fil 11805 CDM 47781-0424-47 NDC facility both 1 EA 106.33 106.33 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES fentaNYL 25 mcg/hr Transderm ER Film [INYO] 11805 CDM 60505-7081-02 NDC facility both 1 EA 106.33 106.33 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES fentaNYL 25 mcg/hr Transderm ER Film [INYO] 11805 CDM 00406-9125-76 NDC facility both 1 EA 72.1 72.1 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES pilocarpine Ophth 1% Sol [INYO] 11810 CDM 61314-0203-15 NDC facility both 1 EA 394.24 394.24 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS predniSONE 1 mg Tab [INYO] 11812 CDM J7512 HCPCS 00054-8739-25 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB predniSONE 1 mg Tab [inyo] 11812 CDM J7512 HCPCS 59746-0171-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB predniSONE 5 mg Tab [INYO] 11813 CDM J7512 HCPCS 60687-0122-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB predniSONE 5 mg Tab [INYO] 11813 CDM J7512 HCPCS 00054-8724-25 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB predniSONE 20 mg Tab [INYO] 11814 CDM J7512 HCPCS 60687-0145-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB predniSONE 20 mg Tab [INYO] 11814 CDM J7512 HCPCS 00904-7127-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB predniSONE 20 mg Tab [INYO] 11814 CDM J7512 HCPCS 00054-0018-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 300 mg Supp [INYO] 11815 CDM 00574-7034-12 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP aspirin 81 mg Chew Tab [INYO] 11817 CDM 66553-0002-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 325 mg Oral EC Tab [INYO] 11818 CDM 57896-0921-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 325 mg Oral EC Tab [INYO] 11818 CDM 00904-2013-60 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB atenolol 25 mg Tab [INYO] 11819 CDM 51079-0759-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB atenolol 25 mg Tab [inyo] 11819 CDM 00904-7187-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bethanechol 10 mg Tab [INYO] 11820 CDM 00832-0511-01 NDC facility both 1 EA 12.01 12.01 Gross Charge Type: Pharmacy | NDC EA = 1 TAB captopril 12.5 mg Tab [INYO] 11821 CDM 60687-0304-21 NDC facility both 1 EA 10.19 10.19 Gross Charge Type: Pharmacy | NDC EA = 1 TAB captopril 12.5 mg Tab [INYO] 11821 CDM 51079-0863-20 NDC facility both 1 EA 10.3 10.3 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cloNIDine 0.1 mg/24 hr Transderm ER Film [INYO] 11829 CDM 00555-1009-16 NDC facility both 1 EA 165.79 165.79 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES cloNIDine 0.1 mg/24 hr Transderm ER Film [INYO] 11829 CDM 00378-0871-99 NDC facility both 1 EA 165.61 165.61 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES digoxin 125 mcg (0.125 mg) Tab [INYO] 11837 CDM 00904-5921-61 NDC facility both 1 EA 10.11 10.11 Gross Charge Type: Pharmacy | NDC EA = 1 TAB digoxin 125 mcg (0.125 mg) Tab [INYO] 11837 CDM 24987-0242-56 NDC facility both 1 EA 17.28 17.28 Gross Charge Type: Pharmacy | NDC EA = 1 TAB APAP-codeine 300 mg-30 mg Tab [INYO] 11839 CDM 00406-0484-62 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 120 mg Supp [INYO] 11841 CDM 45802-0732-30 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP acetaminophen 120 mg Supp [INYO] 11841 CDM 00713-0118-12 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP acetaminophen 325 mg Supp [INYO] 11842 CDM 51672-2116-02 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP acetaminophen 325 mg Supp [INYO] 11842 CDM 00713-0164-12 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP charcoal-sorbitol 25 g Oral Susp 120 mL [INYO] 11843 CDM 00574-0520-74 NDC facility both 120 ML 83.5 83.5 Gross Charge Type: Pharmacy charcoal-sorbitol 25 g Oral Susp 120 mL [INYO] 11843 CDM 00574-0120-74 NDC facility both 120 ML 83.5 83.5 Gross Charge Type: Pharmacy allopurinol 100 mg Tab [INYO] 11845 CDM 00904-6571-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB allopurinol 100 mg Tab [INYO] 11845 CDM 00904-7041-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB allopurinol 100 mg Tab [INYO] 11845 CDM 51079-0205-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amitriptyline 10 mg Tab [INYO] 11847 CDM 70756-0201-11 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amitriptyline 10 mg Tab [INYO] 11847 CDM 51079-0131-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amitriptyline 10 mg Tab [INYO] 11847 CDM 16729-0171-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amoxicillin 250 mg Cap [INYO] 11848 CDM 00781-2020-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ampicillin 1 g Inj [INYO] 11850 CDM J0290 HCPCS 55150-0113-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin 500 mg Inj [INYO] 11851 CDM J0290 HCPCS 00781-3407-95 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy ampicillin 500 mg Inj [INYO] 11851 CDM J0290 HCPCS 25021-0135-10 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy ampicillin 500 mg Inj [INYO] 11851 CDM J0290 HCPCS 65219-0016-10 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy ampicillin 500 mg Inj [INYO] 11851 CDM J0290 HCPCS 55150-0112-10 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy ampicillin 250 mg Inj [INYO] 11852 CDM J0290 HCPCS 25021-0134-10 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy ampicillin 250 mg Inj [INYO] 11852 CDM J0290 HCPCS 00781-3402-95 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy ampicillin 250 mg Inj [INYO] 11852 CDM J0290 HCPCS 00409-3719-01 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy ampicillin 250 mg Inj [INYO] 11852 CDM J0290 HCPCS 55150-0111-10 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy levothyroxine 100 mcg (0.1 mg) Tab [INYO] 11853 CDM 00904-6953-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 100 mcg (0.1 mg) Tab [inyo] 11853 CDM 60687-0497-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 100 mcg (0.1 mg) Tab [INYO] 11853 CDM 51079-0442-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 25 mcg (0.025 mg) Tab [INYO] 11856 CDM 51079-0444-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 25 mcg (0.025 mg) Tab 11856 CDM 00904-6949-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 25 mcg (0.025 mg) Tab [INYO] 11856 CDM 60687-0453-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrocortisone 25 mg Supp [INYO] 11857 CDM 00713-0503-12 NDC facility both 1 EA 135.88 135.88 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP hydrocortisone 25 mg Supp [INYO] 11857 CDM 00574-7090-12 NDC facility both 1 EA 86.55 86.55 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP glipiZIDE 5 mg Tab [INYO] 11858 CDM 00904-6637-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrOXYzine hydrochloride 10 mg Tab [INYO] 11860 CDM 60687-0664-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrOXYzine hydrochloride 10 mg Tab [INYO] 11860 CDM 67405-0575-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrOXYzine hydrochloride 10 mg Tab [INYO] 11860 CDM 63739-0483-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrOXYzine hydrochloride 10 mg Tab [INYO] 11860 CDM 68084-0253-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ibuprofen 600 mg Tab [INYO] 11861 CDM 00904-5854-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ibuprofen 600 mg Tab [INYO] 11861 CDM 60687-0457-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ibuprofen 600 mg Tab [INYO] 11861 CDM 67877-0320-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB insulin isophane-insulin regular human recombinant 70 units-30 units/mL Sus [INYO] 11862 CDM J1815 HCPCS 00002-8715-01 NDC facility both 10 ML 428.26 428.26 Gross Charge Type: Pharmacy isosorbide dinitrate 10 mg Tab [INYO] 11867 CDM 00904-6619-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB isosorbide dinitrate 10 mg Tab [inyo] 11867 CDM 50268-0448-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB isosorbide mononitrate 30 mg ER Tab [INYO] 11870 CDM 00904-6449-61 NDC facility both 1 EA 9.96 9.96 Gross Charge Type: Pharmacy | NDC EA = 1 TAB isosorbide mononitrate 30 mg ER Tab [INYO] 11870 CDM 50268-0451-15 NDC facility both 1 EA 9.86 9.86 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 0.5 mg Tab [INYO] 11872 CDM 00904-6007-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 0.5 mg Tab [INYO] 11872 CDM 00591-0240-10 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 0.5 mg Tab [INYO] 11872 CDM 69315-0904-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB LORazepam 0.5 mg Tab [INYO] 11872 CDM 51079-0417-20 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB medroxyPROGESTERone 5 mg Tab [INYO] 11873 CDM 00555-0873-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB medroxyPROGESTERone 5 mg Tab [INYO] 11873 CDM 00009-0286-03 NDC facility both 1 EA 25.82 25.82 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methocarbamol 500 mg Tab [INYO] 11875 CDM 00904-7057-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methocarbamol 500 mg Tab [INYO] 11875 CDM 60687-0559-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methocarbamol 500 mg Tab [INYO] 11875 CDM 63739-0166-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methocarbamol 500 mg Tab [INYO] 11875 CDM 70010-0754-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metOLazone 2.5 mg Tab UD [INYO] 11876 CDM 51079-0023-20 NDC facility both 1 EA 19.71 19.71 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metOLazone 2.5 mg Tab UD(INYO) 11876 CDM 00904-6916-61 NDC facility both 1 EA 22.52 22.52 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metOLazone 2.5 mg Tab UD(INYO) 11876 CDM 00185-5050-01 NDC facility both 1 EA 12.44 12.44 Gross Charge Type: Pharmacy | NDC EA = 1 TAB morphine 0.5 mg/mL preservative-free Inj Sol [INYO] 11879 CDM J2274 HCPCS 00641-6020-10 NDC facility both 10 ML 278.01 278.01 Gross Charge Type: Pharmacy nalbuphine 10 mg/mL Inj Sol [INYO] 11881 CDM J2300 HCPCS 00409-1463-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy nicotine 14 mg/24 hr Transderm ER Film [INYO] 11883 CDM 00536-5895-53 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nicotine 14 mg/24 hr Transderm ER Film [INYO] 11883 CDM 00536-5895-88 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nicotine 7 mg/24 hr Transderm ER Film [INYO] 11884 CDM 00536-5894-88 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES oxymetazoline Nasal 0.05% Spry [INYO] 11885 CDM 00904-7006-35 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 SPRAYS oxymetazoline Nasal 0.05% Spry [INYO] 11885 CDM 50024-0431-00 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 SPRAYS oxymetazoline Nasal 0.05% Spry [INYO] 11885 CDM 37000-0803-01 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 SPRAYS oxymetazoline Nasal 0.05% Spry [INYO] 11885 CDM 00904-5711-35 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 SPRAYS oxymetazoline Nasal 0.05% Spry [INYO] 11885 CDM 41100-0811-23 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 SPRAYS promethazine 25 mg Supp [INYO] 11890 CDM 00713-0526-12 NDC facility both 1 EA 106.23 106.23 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP promethazine 12.5 mg Supp [INYO] 11891 CDM 00713-0536-12 NDC facility both 1 EA 106.23 106.23 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP pseudoephedrine 30 mg Tab [INYO] 11892 CDM 00904-5053-24 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pseudoephedrine 30 mg Tab 11892 CDM 00904-6990-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pseudoephedrine 30 mg Tab [INYO] 11892 CDM 00904-5053-59 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sertraline 50 mg Tab [INYO] 11893 CDM 00904-6925-61 NDC facility both 1 EA 28.94 28.94 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sertraline 50 mg Tab [INYO] 11893 CDM 60687-0242-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sertraline 50 mg Tab [INYO] 11893 CDM 59762-4900-03 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 25 mg-250 mg Tab [INYO] 11894 CDM 00904-6238-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 25 mg-100 mg Tab 11895 CDM 00904-7257-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 25 mg-100 mg Tab [INYO] 11895 CDM 00904-6237-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 25 mg-100 mg Tab [INYO] 11895 CDM 00228-2539-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 25 mg-100 mg Tab [INYO] 11895 CDM 63739-0047-10 NDC facility both 1 EA 7.6 7.6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 10 mg-100 mg Tab [INYO] 11896 CDM 63739-0107-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 10 mg-100 mg Tab [inyo] 11896 CDM 50228-0457-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 10 mg-100 mg Tab [INYO] 11896 CDM 62756-0517-88 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carbidopa-levodopa 10 mg-100 mg Tab [INYO] 11896 CDM 00228-2538-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB terazosin 5 mg Cap [INYO] 11898 CDM 50268-0766-15 NDC facility both 1 EA 9.63 9.63 Gross Charge Type: Pharmacy | NDC EA = 1 CAP terazosin 5 mg Cap [INYO] 11898 CDM 00904-6128-61 NDC facility both 1 EA 8.67 8.67 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "Phospholipase A2 Receptor Autoantibodies, IgG LC" 11898621 CDM 301 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price "Phospholipase A2 Receptor Autoantibodies, IgG LC" 11898621 CDM 301 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price terbutaline 2.5 mg Tab [INYO] 11899 CDM 10135-0579-01 NDC facility both 1 EA 68.64 68.64 Gross Charge Type: Pharmacy | NDC EA = 1 TAB terbutaline 2.5 mg Tab [INYO] 11899 CDM 00115-2611-01 NDC facility both 1 EA 32.65 32.65 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "11900 Injection, intralesional; up to and including 7 lesions" 11900 CDM 521 RC 11900 HCPCS facility both 102 102 Gross Charge Type: NIHD_RHC_Price "11900 Injection, intralesional; up to and including 7 lesions" 11900 CDM 521 RC 11900 HCPCS facility both 102 102 Gross Charge Type: NIHD_Clinic_Price theophylline 200 mg ER Tab [INYO] 11900 CDM 00904-5888-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "11901 Injection, intralesional; more than 7 lesions" 11901 CDM 521 RC 11901 HCPCS facility both 199 199 Gross Charge Type: NIHD_RHC_Price "11901 Injection, intralesional; more than 7 lesions" 11901 CDM 521 RC 11901 HCPCS facility both 199 199 Gross Charge Type: NIHD_Clinic_Price thyroid desiccated 30 mg Tab [INYO] 11904 CDM 00456-0458-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ofloxacin Ophth 0.3% Sol [INYO] 11905 CDM 64980-0515-01 NDC facility both 1 EA 542.64 542.64 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS ofloxacin Ophth 0.3% Sol [INYO] 11905 CDM 17478-0713-10 NDC facility both 1 EA 251.28 251.28 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS sodium chloride Nasal 0.65% Spry [INYO] 11906 CDM 56184-0120-11 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 30 SPRAYS sodium chloride Nasal 0.65% Spry [INYO] 11906 CDM 00904-3865-75 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 30 SPRAYS "nystatin Top 100,000 units/g Crm [INYO]" 11907 CDM 45802-0059-35 NDC facility both 1 EA 87.5 87.5 Gross Charge Type: Pharmacy | NDC EA = 15 APP "nystatin Top 100,000 units/g Crm [INYO]" 11907 CDM 00603-7818-74 NDC facility both 1 EA 87.5 87.5 Gross Charge Type: Pharmacy | NDC EA = 15 APP timolol Ophth 0.25% Sol [INYO] 11913 CDM 61314-0226-05 NDC facility both 1 EA 90 90 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS timolol Ophth 0.25% Sol [INYO] 11913 CDM 64980-0513-05 NDC facility both 1 EA 90 90 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS timolol Ophth 0.25% Sol [INYO] 11913 CDM 60758-0802-05 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS warfarin 10 mg Tab [INYO] 11915 CDM 00056-0174-75 NDC facility both 1 EA 23.03 23.03 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 2.5 mg Tab [INYO] 11916 CDM 00832-1213-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 2.5 mg Tab [INYO] 11916 CDM 68084-0027-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 2.5 mg Tab [INYO] 11916 CDM 00056-0176-75 NDC facility both 1 EA 15.98 15.98 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 2 mg Tab [INYO] 11917 CDM 00832-1212-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 2 mg Tab [INYO] 11917 CDM 62584-0984-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 2 mg Tab [INYO] 11917 CDM 00056-0170-75 NDC facility both 1 EA 15.49 15.49 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ketorolac 15 mg/mL Inj Sol [INYO] 11918 CDM J1885 HCPCS 72266-0234-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ketorolac 15 mg/mL Inj Sol [INYO] 11918 CDM J1885 HCPCS 63323-0161-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ketorolac 15 mg/mL Inj Sol [INYO] 11918 CDM J1885 HCPCS 00409-3793-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ketorolac 15 mg/mL Inj Sol [INYO] 11918 CDM J1885 HCPCS 72611-0719-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy gentamicin Ophth 0.3% Oint [INYO] 11919 CDM 17478-0284-35 NDC facility both 1 EA 212.64 212.64 Gross Charge Type: Pharmacy | NDC EA = 3.5 APP Penicillin V Potassium 125 mg/5 mL Pow [INYO] 11921 CDM 00093-4125-74 NDC facility both 200 ML 67 67 Gross Charge Type: Pharmacy warfarin 1 mg Tab [INYO] 11923 CDM 00056-0169-75 NDC facility both 1 EA 14.85 14.85 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 1 mg Tab [INYO] 11923 CDM 00832-1211-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB promethazine 50 mg Supp [INYO] 11962 CDM 00713-0132-12 NDC facility both 1 EA 214.59 214.59 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP PHENobarbital 65 mg/mL Sol [INYO] 11967 CDM J2560 HCPCS 42494-0415-25 NDC facility both 1 ML 209.47 209.47 Gross Charge Type: Pharmacy PHENobarbital 65 mg/mL Inj Sol [INYO] 11967 CDM J2560 HCPCS 00641-0476-25 NDC facility both 1 ML 230.21 230.21 Gross Charge Type: Pharmacy "11976 Removal, implantable contraceptive capsules" 11976 CDM 521 RC 11976 HCPCS facility both 713 713 Gross Charge Type: NIHD_RHC_Price ADAPTIC DRESSING 3X3 (50EA) 11980 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTIC DRESSING 3X3 (50EA) 11980 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "11981 Insertion, non-biodegradable drug delivery implant" 119811 CDM 521 RC 11981 HCPCS facility both 355 355 Gross Charge Type: NIHD_Clinic_Price "11981 INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ProFee" 119812 CDM 982 RC 11981 HCPCS facility both 355 355 Gross Charge Type: NIHD_Hosp_Profee_Price "11981 INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ProFee" 119812 CDM 982 RC 11981 HCPCS facility both 355 355 Gross Charge Type: NIHD_Hosp_Profee_Price "11982 Removal, non-biodegradable drug delivery implant" 11982 CDM 975 RC 11982 HCPCS facility both 130 130 Gross Charge Type: NIHD_Hosp_Profee_Price "11982 Removal, non-biodegradable drug delivery implant" 11982 CDM 975 RC 11982 HCPCS facility both 130 130 Gross Charge Type: NIHD_Hosp_Profee_Price "11982 Removal, non-biodegradable drug delivery implant" 119821 CDM 521 RC 11982 HCPCS facility both 301 301 Gross Charge Type: NIHD_Clinic_Price "11982 REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ProFee" 119822 CDM 975 RC 11982 HCPCS facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price "11982 REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ProFee" 119822 CDM 975 RC 11982 HCPCS facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price "11983 Removal with reinsertion, non-biodegradable drug delivery implant" 11983 CDM 521 RC 11983 HCPCS facility both 330 330 Gross Charge Type: NIHD_Clinic_Price predniSONE 10 mg Tab [INYO] 11990 CDM J7512 HCPCS 00904-6923-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB predniSONE 10 mg Tab [INYO] 11990 CDM J7512 HCPCS 60687-0134-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB predniSONE 10 mg Tab [INYO] 11990 CDM J7512 HCPCS 00054-0017-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm" 120011 CDM 521 RC 12001 HCPCS facility both 350 350 Gross Charge Type: NIHD_RHC_Price "12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm" 120011 CDM 521 RC 12001 HCPCS facility both 528 528 Gross Charge Type: NIHD_Clinic_Price 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee 120012 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee 120012 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "12001 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120013 CDM 982 RC 12001 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "12001 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120013 CDM 982 RC 12001 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm" 120021 CDM 521 RC 12002 HCPCS facility both 506 506 Gross Charge Type: NIHD_RHC_Price "12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm" 120021 CDM 521 RC 12002 HCPCS facility both 506 506 Gross Charge Type: NIHD_Clinic_Price 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee 120022 CDM 450 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee 120022 CDM 450 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "12002 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120023 CDM 982 RC 12002 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "12002 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120023 CDM 982 RC 12002 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "12004 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 7.6-12.5cm" 120041 CDM 521 RC 12004 HCPCS facility both 662 662 Gross Charge Type: NIHD_RHC_Price 12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee 120042 CDM 450 RC facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price 12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee 120042 CDM 450 RC facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price "12004 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120043 CDM 982 RC 12004 HCPCS facility both 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price "12004 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120043 CDM 982 RC 12004 HCPCS facility both 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price 12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee 120051 CDM 450 RC facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price 12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee 120051 CDM 450 RC facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price "12005 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120052 CDM 982 RC 12005 HCPCS facility both 332 332 Gross Charge Type: NIHD_Hosp_Profee_Price "12005 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120052 CDM 982 RC 12005 HCPCS facility both 332 332 Gross Charge Type: NIHD_Hosp_Profee_Price 12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM TechFee 120061 CDM 450 RC facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price 12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM TechFee 120061 CDM 450 RC facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "12006 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120062 CDM 982 RC 12006 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price "12006 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120062 CDM 982 RC 12006 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 12007 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM TechFee 120071 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 12007 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM TechFee 120071 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "12007 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120072 CDM 982 RC 12007 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "12007 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee" 120072 CDM 982 RC 12007 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm" 120111 CDM 521 RC 12011 HCPCS facility both 467 467 Gross Charge Type: NIHD_RHC_Price "12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm" 120111 CDM 521 RC 12011 HCPCS facility both 639 639 Gross Charge Type: NIHD_Clinic_Price 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee 120112 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee 120112 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "12011 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120113 CDM 982 RC 12011 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "12011 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120113 CDM 982 RC 12011 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "12013 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; 2.6-5.0cm" 120131 CDM 521 RC 12013 HCPCS facility both 720 720 Gross Charge Type: NIHD_RHC_Price "12013 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; 2.6-5.0cm" 120131 CDM 521 RC 12013 HCPCS facility both 720 720 Gross Charge Type: NIHD_Clinic_Price 12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee 120132 CDM 450 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee 120132 CDM 450 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "12013 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120133 CDM 982 RC 12013 HCPCS facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price "12013 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120133 CDM 982 RC 12013 HCPCS facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price 12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee 120141 CDM 450 RC facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price 12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee 120141 CDM 450 RC facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price "12014 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120142 CDM 982 RC 12014 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "12014 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120142 CDM 982 RC 12014 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price 12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM TechFee 120151 CDM 450 RC facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price 12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM TechFee 120151 CDM 450 RC facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price "12015 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120152 CDM 982 RC 12015 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "12015 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120152 CDM 982 RC 12015 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 12016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM TechFee 120161 CDM 450 RC facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price 12016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM TechFee 120161 CDM 450 RC facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "12016 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120162 CDM 982 RC 12016 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "12016 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee" 120162 CDM 982 RC 12016 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price 12020 Treatment of superficial wound dehiscence; simple closure 120201 CDM 521 RC 12020 HCPCS facility both 338 338 Gross Charge Type: NIHD_Clinic_Price 12020 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE ProFee 120202 CDM 982 RC 12020 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 12020 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE ProFee 120202 CDM 982 RC 12020 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE TechFee 120203 CDM 450 RC facility both 2112 2112 Gross Charge Type: NIHD_Hosp_Profee_Price 12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE TechFee 120203 CDM 450 RC facility both 2112 2112 Gross Charge Type: NIHD_Hosp_Profee_Price 12021 Treatment of superficial wound dehiscence; with packing 120211 CDM 521 RC 12021 HCPCS facility both 661 661 Gross Charge Type: NIHD_RHC_Price 12021 Treatment of superficial wound dehiscence; with packing 120211 CDM 521 RC 12021 HCPCS facility both 617 617 Gross Charge Type: NIHD_Clinic_Price 12021 TX SUPERFICIAL WOUND DEHISCENCE W/PACKING TechFee 120212 CDM 450 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price 12021 TX SUPERFICIAL WOUND DEHISCENCE W/PACKING TechFee 120212 CDM 450 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price 12021 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING ProFee 120213 CDM 982 RC 12021 HCPCS facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price 12021 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING ProFee 120213 CDM 982 RC 12021 HCPCS facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price "12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm" 120311 CDM 521 RC 12031 HCPCS facility both 546 546 Gross Charge Type: NIHD_RHC_Price "12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm" 120311 CDM 521 RC 12031 HCPCS facility both 501 501 Gross Charge Type: NIHD_Clinic_Price 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee 120312 CDM 450 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee 120312 CDM 450 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "12031 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120313 CDM 982 RC 12031 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "12031 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120313 CDM 982 RC 12031 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "12032 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; 2.6-7.5cm" 120321 CDM 521 RC 12032 HCPCS facility both 698 698 Gross Charge Type: NIHD_RHC_Price "12032 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; 2.6-7.5cm" 120321 CDM 521 RC 12032 HCPCS facility both 632 632 Gross Charge Type: NIHD_Clinic_Price 12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM TechFee 120322 CDM 450 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM TechFee 120322 CDM 450 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "12032 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120323 CDM 982 RC 12032 HCPCS facility both 638 638 Gross Charge Type: NIHD_Hosp_Profee_Price "12032 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120323 CDM 982 RC 12032 HCPCS facility both 638 638 Gross Charge Type: NIHD_Hosp_Profee_Price 12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM TechFee 120341 CDM 450 RC facility both 736 736 Gross Charge Type: NIHD_Hosp_Profee_Price 12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM TechFee 120341 CDM 450 RC facility both 736 736 Gross Charge Type: NIHD_Hosp_Profee_Price "12034 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120342 CDM 982 RC 12034 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "12034 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120342 CDM 982 RC 12034 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "12034 LAYER CLOSURE OF WOUND(S),SCALP,7.6-12.5CM" 120343 CDM 521 RC 12034 HCPCS facility both 526 526 Gross Charge Type: NIHD_RHC_Price "12034 LAYER CLOSURE OF WOUND(S),SCALP,7.6-12.5CM" 120343 CDM 521 RC 12034 HCPCS facility both 526 526 Gross Charge Type: NIHD_Clinic_Price 12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM TechFee 120351 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM TechFee 120351 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price "12035 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120352 CDM 982 RC 12035 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price "12035 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120352 CDM 982 RC 12035 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price 12036 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM TechFee 120361 CDM 450 RC facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price 12036 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM TechFee 120361 CDM 450 RC facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "12036 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120362 CDM 982 RC 12036 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "12036 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 120362 CDM 982 RC 12036 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "12037 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 12037 CDM 975 RC 12037 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "12037 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee" 12037 CDM 975 RC 12037 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "12041 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; <2.5cm" 120411 CDM 521 RC 12041 HCPCS facility both 288 288 Gross Charge Type: NIHD_Clinic_Price 12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee 120412 CDM 450 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee 120412 CDM 450 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "12041 REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR ProFee" 120413 CDM 982 RC 12041 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "12041 REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR ProFee" 120413 CDM 982 RC 12041 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "12042 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6-7.5cm" 120421 CDM 521 RC 12042 HCPCS facility both 370 370 Gross Charge Type: NIHD_Clinic_Price 12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee 120422 CDM 450 RC facility both 736 736 Gross Charge Type: NIHD_Hosp_Profee_Price 12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee 120422 CDM 450 RC facility both 736 736 Gross Charge Type: NIHD_Hosp_Profee_Price "12042 REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO ProFee" 120423 CDM 982 RC 12042 HCPCS facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price "12042 REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO ProFee" 120423 CDM 982 RC 12042 HCPCS facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price "12044 REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 7.6 CM TO ProFee" 12044 CDM 982 RC 12044 HCPCS facility both 652 652 Gross Charge Type: NIHD_Hosp_Profee_Price "12044 REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 7.6 CM TO ProFee" 12044 CDM 982 RC 12044 HCPCS facility both 652 652 Gross Charge Type: NIHD_Hosp_Profee_Price "12051 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; <2.5cm" 120511 CDM 521 RC 12051 HCPCS facility both 351 351 Gross Charge Type: NIHD_Clinic_Price 12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< TechFee 120512 CDM 450 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< TechFee 120512 CDM 450 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "12051 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 120513 CDM 982 RC 12051 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "12051 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 120513 CDM 982 RC 12051 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM TechFee 120521 CDM 450 RC facility both 736 736 Gross Charge Type: NIHD_Hosp_Profee_Price 12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM TechFee 120521 CDM 450 RC facility both 736 736 Gross Charge Type: NIHD_Hosp_Profee_Price "12052 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 120522 CDM 982 RC 12052 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "12052 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 120522 CDM 982 RC 12052 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "12052 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; 2.6-5.0cm" 120523 CDM 521 RC 12052 HCPCS facility both 497 497 Gross Charge Type: NIHD_RHC_Price "12052 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; 2.6-5.0cm" 120523 CDM 521 RC 12052 HCPCS facility both 497 497 Gross Charge Type: NIHD_Clinic_Price 12053 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM TechFee 120531 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 12053 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM TechFee 120531 CDM 450 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price "12053 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 120532 CDM 982 RC 12053 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "12053 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 120532 CDM 982 RC 12053 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "12053 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; 5.1-7.5cm" 120533 CDM 521 RC 12053 HCPCS facility both 574 574 Gross Charge Type: NIHD_RHC_Price "12053 Intermed repair of wounds; face, ears, eyelids, nose, lips, mucous membra; 5.1-7.5cm" 120533 CDM 521 RC 12053 HCPCS facility both 574 574 Gross Charge Type: NIHD_Clinic_Price 12054 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM TechFee 120541 CDM 450 RC facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price 12054 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM TechFee 120541 CDM 450 RC facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "12054 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 120542 CDM 982 RC 12054 HCPCS facility both 1424 1424 Gross Charge Type: NIHD_Hosp_Profee_Price "12054 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 120542 CDM 982 RC 12054 HCPCS facility both 1424 1424 Gross Charge Type: NIHD_Hosp_Profee_Price "12055 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 12055 CDM 982 RC 12055 HCPCS facility both 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price "12055 REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANE ProFee" 12055 CDM 982 RC 12055 HCPCS facility both 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price terazosin 1 mg Cap [INYO] 12066 CDM 50268-0764-15 NDC facility both 1 EA 9.63 9.63 Gross Charge Type: Pharmacy | NDC EA = 1 CAP terazosin 1 mg Cap [INYO] 12066 CDM 00904-6126-61 NDC facility both 1 EA 8.67 8.67 Gross Charge Type: Pharmacy | NDC EA = 1 CAP terbutaline 1 mg/mL Inj Sol [INYO] 12068 CDM J3105 HCPCS 00143-9746-10 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy terbutaline 1 mg/mL Inj Sol [INYO] 12068 CDM J3105 HCPCS 63323-0665-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy warfarin 5 mg Tab [INYO] 12108 CDM 62584-0994-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 5 mg Tab [INYO] 12108 CDM 00832-1216-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB warfarin 5 mg Tab [INYO] 12108 CDM 00056-0172-75 NDC facility both 1 EA 16.66 16.66 Gross Charge Type: Pharmacy | NDC EA = 1 TAB prochlorperazine 25 mg Supp [INYO] 12125 CDM 00713-0135-12 NDC facility both 1 EA 73.55 73.55 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP prochlorperazine 25 mg Sup [inyo] 12125 CDM 00574-7226-12 NDC facility both 1 EA 75.5 75.5 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP Intact N-Terminal Propeptide of Type 1 Procollagen LC 140850 12134072 CDM 301 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price Intact N-Terminal Propeptide of Type 1 Procollagen LC 140850 12134072 CDM 301 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price XEROFORM GAUZE 5X9 12159 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price XEROFORM GAUZE 5X9 12159 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price Amino Acids 10% (Aminosyn II Sulfite-Free) IV Sol 500 mL [INYO] 12170 CDM 00409-4164-03 NDC facility both 500 ML 330 330 Gross Charge Type: Pharmacy lactulose 20 g/30 mL Oral Syrup [INYO] 12201 CDM 00121-1154-40 NDC facility both 30 ML 6 6 Gross Charge Type: Pharmacy lactulose 20 g/30 mL Oral Syrup [INYO] 12201 CDM 00121-4577-30 NDC facility both 30 ML 6 6 Gross Charge Type: Pharmacy lactulose 20 g/30 mL Oral Syrup [INYO] 12201 CDM 50383-0779-31 NDC facility both 30 ML 17.88 17.88 Gross Charge Type: Pharmacy lactulose 20 g/30 mL Oral Syrup [INYO] 12201 CDM 66689-0038-50 NDC facility both 30 ML 10.04 10.04 Gross Charge Type: Pharmacy t-Transglutaminase (tTG) IgA LC 12205872 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 12205872 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgG LC" 12205873 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgG LC" 12205873 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price vancomycin 500 mg IV inj [INYO] 12209 CDM J3370 HCPCS 70594-0122-02 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy vancomycin 500 mg IV Inj [INYO] 12209 CDM J3370 HCPCS 67457-0339-50 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy vancomycin 500 mg IV Inj [INYO] 12209 CDM J3370 HCPCS 47781-0598-91 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy vancomycin 500 mg IV Inj [INYO] 12209 CDM J3370 HCPCS 72611-0761-10 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy vancomycin 500 mg IV Inj [INYO] 12209 CDM J3370 HCPCS 00409-4332-01 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy sulfamethoxazole-trimethoprim 80 mg-16 mg/mL IV Sol 10 mL [INYO] 12214 CDM J3490 HCPCS 00703-9514-03 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy prazosin 1 mg Cap [INYO] 12238 CDM 00378-1101-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP prazosin 1 mg Cap [INYO] 12238 CDM 00904-7020-61 NDC facility both 1 EA 9.71 9.71 Gross Charge Type: Pharmacy | NDC EA = 1 CAP prazosin 1 mg Cap [INYO] 12238 CDM 68084-0996-01 NDC facility both 1 EA 10.71 10.71 Gross Charge Type: Pharmacy | NDC EA = 1 CAP sodium hypochlorite Top 0.25% Sol [INYO] 12285 CDM 39328-0063-25 NDC facility both 1 EA 63.75 63.75 Gross Charge Type: Pharmacy | NDC EA = 473 APP metoprolol 50 mg Tab [inyo] 12291 CDM 00904-7118-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoprolol TARTrate 50 mg Tab [INYO] 12291 CDM 51079-0801-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoprolol TARTrate 50 mg Tab [INYO] 12291 CDM 00904-6341-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoprolol 5 mg/5 mL Inj Sol [INYO] 12293 CDM 36000-0033-10 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy metoprolol 5 mg/5 mL Inj Sol [INYO] 12293 CDM 63323-0660-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy metoprolol 5 mg/5 mL Inj Sol [INYO] 12293 CDM 00409-2285-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy timolol Ophth 0.5% Sol 5mL [INYO] 12325 CDM 61314-0227-05 NDC facility both 1 EA 102 102 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS timolol Ophth 0.5% Sol 5mL [INYO] 12325 CDM 64980-0514-05 NDC facility both 1 EA 102 102 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS benztropine 1 mg Tab [INYO] 12379 CDM 00904-7289-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB benztropine 1 mg Tab [INYO] 12379 CDM 00904-6790-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB benztropine 1 mg Tab [INYO] 12379 CDM 00904-6540-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB atropine/hyoscyamine/PB/scopolamine Oral Elix 118 mL [INYO] 12399 CDM 75826-0127-04 NDC facility both 10 ML 135.61 135.61 Gross Charge Type: Pharmacy atropine/hyoscyamine/PB/scopolamine Oral Elix 118 mL [INYO] 12399 CDM 59212-0423-04 NDC facility both 10 ML 197.8 197.8 Gross Charge Type: Pharmacy enalapril 1.25 mg/mL IV Sol [INYO] 12404 CDM J3490 HCPCS 00143-9787-10 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy enalapril 1.25 mg/mL 2 mL Sol [INYO] 12420 CDM 00143-9786-10 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy Multiple Vitamins IV Sol 5 mL [INYO] 12436 CDM 54643-5649-01 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy bismuth subsalicylate 262 mg Chew Tab [INYO] 12445 CDM 37000-0477-12 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bismuth subsalicylate 262 mg Tab [inyo] 12445 CDM 00904-7205-46 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bismuth subsalicylate 262 mg Chew Tab [INYO] 12445 CDM 00904-1315-46 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bismuth subsalicylate 236 mL Oral Susp [INYO] 12446 CDM 00904-1313-09 NDC facility both 236 ML 18.78 18.78 Gross Charge Type: Pharmacy bismuth subsalicylate 236 mL Oral Susp [INYO] 12446 CDM 01490-0039-08 NDC facility both 236 ML 17.76 17.76 Gross Charge Type: Pharmacy bismuth subsalicylate 236 mL Oral Susp [INYO] 12446 CDM 37000-0032-02 NDC facility both 236 ML 27.02 27.02 Gross Charge Type: Pharmacy PHENobarbital 32.4 mg Tab [INYO] 12449 CDM 00904-6575-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB PHENobarbital 32.4 mg Tab [INYO] 12449 CDM 00603-5166-21 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB phenylephrine Nasal 0.5% Spry [INYO] 12456 CDM 00225-0805-47 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 SPRAYS phenylephrine Nasal 0.5% Spry [INYO] 12456 CDM 69536-0050-15 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 SPRAYS phenylephrine Nasal 0.5% Spry [INYO] 12456 CDM 50323-0060-03 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 SPRAYS phenytoin 50 mg Chew Tab [INYO] 12458 CDM 00071-0007-40 NDC facility both 1 EA 13.02 13.02 Gross Charge Type: Pharmacy | NDC EA = 1 TAB triamcinolone Top 0.1% Crm [INYO] 12477 CDM 67877-0251-15 NDC facility both 1 EA 29.15 29.15 Gross Charge Type: Pharmacy | NDC EA = 15 APP clindamycin 900 mg/6 mL Sol [INYO] 12478 CDM J0736 HCPCS 00009-0902-18 NDC facility both 6 ML 235 235 Gross Charge Type: Pharmacy cholecalciferol 400 intl units Cap [INYO] 12487 CDM 11845-0118-31 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP CENTRALIZER DISTAL VERSYS 15MM 125 CDM facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price CENTRALIZER DISTAL VERSYS 15MM 125 CDM facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price cefOXitin 1 g Pow [INYO] 12511 CDM J0694 HCPCS 25021-0109-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefOXitin 1 g Pow [INYO] 12511 CDM J0694 HCPCS 44567-0245-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy metoclopramide 10 mg Tab [INYO] 12519 CDM 60687-0631-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoclopramide 10 mg Tab [INYO] 12519 CDM 68084-0676-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoclopramide 10 mg Tab [INYO] 12519 CDM 51079-0888-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoclopramide 10 mg/2 mL Inj Sol [INYO] 12522 CDM J2765 HCPCS 00409-3414-01 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy metoclopramide 5 mg/mL Sol [inyo] 12522 CDM J2765 HCPCS 23155-0240-41 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy metoclopramide 5 mg/5 mL Oral Syrup [INYO] 12523 CDM 00121-0576-16 NDC facility both 473 ML 184.4 184.4 Gross Charge Type: Pharmacy metoclopramide 5 mg/5 mL Oral Syrup [INYO] 12523 CDM 62559-0190-16 NDC facility both 473 ML 402.81 402.81 Gross Charge Type: Pharmacy NEEDLE BONE BIOPSY 11G OSTEO-SITE M2 1301800 CDM facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE BONE BIOPSY 11G OSTEO-SITE M2 1301800 CDM facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price "13100 Repair, complex, trunk; 1.1 cm to 2.5 cm" 131001 CDM 521 RC 13100 HCPCS facility both 613 613 Gross Charge Type: NIHD_RHC_Price "13100 Repair, complex, trunk; 1.1 cm to 2.5 cm" 131001 CDM 521 RC 13100 HCPCS facility both 613 613 Gross Charge Type: NIHD_Clinic_Price 13100 REPAIR COMPLEX TRUNK 1.1-2.5 CM TechFee 131002 CDM 450 RC facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price 13100 REPAIR COMPLEX TRUNK 1.1-2.5 CM TechFee 131002 CDM 450 RC facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "13100 REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM ProFee" 131003 CDM 982 RC 13100 HCPCS facility both 358 358 Gross Charge Type: NIHD_Hosp_Profee_Price "13100 REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM ProFee" 131003 CDM 982 RC 13100 HCPCS facility both 358 358 Gross Charge Type: NIHD_Hosp_Profee_Price "13101 Repair, complex, trunk; 2.6 cm to 7.5 cm" 131011 CDM 521 RC 13101 HCPCS facility both 719 719 Gross Charge Type: NIHD_RHC_Price "13101 Repair, complex, trunk; 2.6 cm to 7.5 cm" 131011 CDM 521 RC 13101 HCPCS facility both 719 719 Gross Charge Type: NIHD_Clinic_Price 13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM TechFee 131012 CDM 450 RC facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price 13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM TechFee 131012 CDM 450 RC facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "13101 REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM ProFee" 131013 CDM 982 RC 13101 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "13101 REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM ProFee" 131013 CDM 982 RC 13101 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "13102 Repair, complex, trunk; each additional 5 cm or less" 131021 CDM 521 RC 13102 HCPCS facility both 215 215 Gross Charge Type: NIHD_RHC_Price "13102 Repair, complex, trunk; each additional 5 cm or less" 131021 CDM 521 RC 13102 HCPCS facility both 215 215 Gross Charge Type: NIHD_Clinic_Price 13102 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< TechFee 131022 CDM 450 RC facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price 13102 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< TechFee 131022 CDM 450 RC facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "13102 REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO C ProFee" 131023 CDM 982 RC 13102 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "13102 REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO C ProFee" 131023 CDM 982 RC 13102 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "13120 Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm" 131201 CDM 521 RC 13120 HCPCS facility both 638 638 Gross Charge Type: NIHD_RHC_Price "13120 Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm" 131201 CDM 521 RC 13120 HCPCS facility both 638 638 Gross Charge Type: NIHD_Clinic_Price "13120 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM ProFee" 131202 CDM 982 RC 13120 HCPCS facility both 436 436 Gross Charge Type: NIHD_Hosp_Profee_Price "13120 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM ProFee" 131202 CDM 982 RC 13120 HCPCS facility both 436 436 Gross Charge Type: NIHD_Hosp_Profee_Price "13121 Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm" 131211 CDM 521 RC 13121 HCPCS facility both 771 771 Gross Charge Type: NIHD_RHC_Price "13121 Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm" 131211 CDM 521 RC 13121 HCPCS facility both 771 771 Gross Charge Type: NIHD_Clinic_Price 13121 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM TechFee 131212 CDM 450 RC facility both 1733 1733 Gross Charge Type: NIHD_Hosp_Profee_Price 13121 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM TechFee 131212 CDM 450 RC facility both 1733 1733 Gross Charge Type: NIHD_Hosp_Profee_Price "13121 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM ProFee" 131213 CDM 982 RC 13121 HCPCS facility both 538 538 Gross Charge Type: NIHD_Hosp_Profee_Price "13121 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM ProFee" 131213 CDM 982 RC 13121 HCPCS facility both 538 538 Gross Charge Type: NIHD_Hosp_Profee_Price "13122 Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less" 131221 CDM 521 RC 13122 HCPCS facility both 234 234 Gross Charge Type: NIHD_RHC_Price "13122 Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less" 131221 CDM 521 RC 13122 HCPCS facility both 234 234 Gross Charge Type: NIHD_Clinic_Price 13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< TechFee 131222 CDM 450 RC facility both 1106 1106 Gross Charge Type: NIHD_Hosp_Profee_Price 13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< TechFee 131222 CDM 450 RC facility both 1106 1106 Gross Charge Type: NIHD_Hosp_Profee_Price "13122 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATE ProFee" 131223 CDM 982 RC 13122 HCPCS facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price "13122 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATE ProFee" 131223 CDM 982 RC 13122 HCPCS facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price "13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; 1.1-2.5cm" 131311 CDM 521 RC 13131 HCPCS facility both 698 698 Gross Charge Type: NIHD_RHC_Price "13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; 1.1-2.5cm" 131311 CDM 521 RC 13131 HCPCS facility both 698 698 Gross Charge Type: NIHD_Clinic_Price "13131 REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR ProFee" 131312 CDM 982 RC 13131 HCPCS facility both 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price "13131 REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR ProFee" 131312 CDM 982 RC 13131 HCPCS facility both 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price 13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM TechFee 131313 CDM 450 RC facility both 1207 1207 Gross Charge Type: NIHD_Hosp_Profee_Price 13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM TechFee 131313 CDM 450 RC facility both 1207 1207 Gross Charge Type: NIHD_Hosp_Profee_Price "13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; 2.6-7.5cm" 131321 CDM 521 RC 13132 HCPCS facility both 854 854 Gross Charge Type: NIHD_RHC_Price "13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; 2.6-7.5cm" 131321 CDM 521 RC 13132 HCPCS facility both 854 854 Gross Charge Type: NIHD_Clinic_Price "13132 REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR ProFee" 131322 CDM 982 RC 13132 HCPCS facility both 573 573 Gross Charge Type: NIHD_Hosp_Profee_Price "13132 REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR ProFee" 131322 CDM 982 RC 13132 HCPCS facility both 573 573 Gross Charge Type: NIHD_Hosp_Profee_Price 13132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM TechFee 131323 CDM 450 RC facility both 1727 1727 Gross Charge Type: NIHD_Hosp_Profee_Price 13132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM TechFee 131323 CDM 450 RC facility both 1727 1727 Gross Charge Type: NIHD_Hosp_Profee_Price "13133 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; addl 5cm" 131331 CDM 521 RC 13133 HCPCS facility both 309 309 Gross Charge Type: NIHD_RHC_Price "13133 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands; addl 5cm" 131331 CDM 521 RC 13133 HCPCS facility both 309 309 Gross Charge Type: NIHD_Clinic_Price "13133 REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR ProFee" 131332 CDM 982 RC 13133 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "13133 REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR ProFee" 131332 CDM 982 RC 13133 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm" 131511 CDM 521 RC 13151 HCPCS facility both 760 760 Gross Charge Type: NIHD_RHC_Price "13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm" 131511 CDM 521 RC 13151 HCPCS facility both 760 760 Gross Charge Type: NIHD_Clinic_Price "13151 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM ProFee" 131512 CDM 982 RC 13151 HCPCS facility both 500 500 Gross Charge Type: NIHD_Hosp_Profee_Price "13151 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM ProFee" 131512 CDM 982 RC 13151 HCPCS facility both 500 500 Gross Charge Type: NIHD_Hosp_Profee_Price "13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm" 131521 CDM 521 RC 13152 HCPCS facility both 901 901 Gross Charge Type: NIHD_RHC_Price "13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm" 131521 CDM 521 RC 13152 HCPCS facility both 901 901 Gross Charge Type: NIHD_Clinic_Price "13152 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM ProFee" 131522 CDM 982 RC 13152 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "13152 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM ProFee" 131522 CDM 982 RC 13152 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "13153 Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less" 131531 CDM 521 RC 13153 HCPCS facility both 338 338 Gross Charge Type: NIHD_RHC_Price "13153 Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less" 131531 CDM 521 RC 13153 HCPCS facility both 338 338 Gross Charge Type: NIHD_Clinic_Price "13153 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS (LIST S ProFee" 131532 CDM 982 RC 13153 HCPCS facility both 245 245 Gross Charge Type: NIHD_Hosp_Profee_Price "13153 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS (LIST S ProFee" 131532 CDM 982 RC 13153 HCPCS facility both 245 245 Gross Charge Type: NIHD_Hosp_Profee_Price "13160 SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED ProFee" 13160 CDM 982 RC 13160 HCPCS facility both 1585 1585 Gross Charge Type: NIHD_Hosp_Profee_Price "13160 SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED ProFee" 13160 CDM 982 RC 13160 HCPCS facility both 1585 1585 Gross Charge Type: NIHD_Hosp_Profee_Price "BB-TAK, MTP, THREADED" 1322700 CDM 278 RC facility both 255 255 Gross Charge Type: NIHD_Hosp_Profee_Price "BB-TAK, MTP, THREADED" 1322700 CDM 278 RC facility both 255 255 Gross Charge Type: NIHD_Hosp_Profee_Price Major Additional 15 Min 1378482 CDM 360 RC facility both 3185 3185 Gross Charge Type: NIHD_Hosp_Profee_Price Major Additional 15 Min 1378482 CDM 360 RC facility both 3185 3185 Gross Charge Type: NIHD_Hosp_Profee_Price Echocardiogram Transesophageal 1378485 CDM 360 RC facility both 1973 1973 Gross Charge Type: NIHD_Hosp_Profee_Price Echocardiogram Transesophageal 1378485 CDM 360 RC facility both 1973 1973 Gross Charge Type: NIHD_Hosp_Profee_Price "14000 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less" 140001 CDM 521 RC 14000 HCPCS facility both 1112 1112 Gross Charge Type: NIHD_RHC_Price "14000 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less" 140001 CDM 521 RC 14000 HCPCS facility both 1112 1112 Gross Charge Type: NIHD_Clinic_Price "14000 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS ProFee" 140002 CDM 982 RC 14000 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price "14000 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS ProFee" 140002 CDM 982 RC 14000 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price "14001 Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm" 140011 CDM 521 RC 14001 HCPCS facility both 1413 1413 Gross Charge Type: NIHD_RHC_Price "14001 Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm" 140011 CDM 521 RC 14001 HCPCS facility both 1413 1413 Gross Charge Type: NIHD_Clinic_Price "14001 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM ProFee" 140012 CDM 982 RC 14001 HCPCS facility both 1135 1135 Gross Charge Type: NIHD_Hosp_Profee_Price "14001 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM ProFee" 140012 CDM 982 RC 14001 HCPCS facility both 1135 1135 Gross Charge Type: NIHD_Hosp_Profee_Price "14020 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect < 10 sq cm" 140201 CDM 521 RC 14020 HCPCS facility both 1238 1238 Gross Charge Type: NIHD_RHC_Price "14020 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect < 10 sq cm" 140201 CDM 521 RC 14020 HCPCS facility both 12367 12367 Gross Charge Type: NIHD_Clinic_Price "14020 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR ProFee" 140202 CDM 982 RC 14020 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "14020 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR ProFee" 140202 CDM 982 RC 14020 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "14021 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0" 140211 CDM 521 RC 14021 HCPCS facility both 1534 1534 Gross Charge Type: NIHD_RHC_Price "14021 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0" 140211 CDM 521 RC 14021 HCPCS facility both 1534 1534 Gross Charge Type: NIHD_Clinic_Price "14021 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1 SQ CM ProFee" 140212 CDM 982 RC 14021 HCPCS facility both 1254 1254 Gross Charge Type: NIHD_Hosp_Profee_Price "14021 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1 SQ CM ProFee" 140212 CDM 982 RC 14021 HCPCS facility both 1254 1254 Gross Charge Type: NIHD_Hosp_Profee_Price "14040 Adjacent tissue transfer; forehead, cheeks, chin, mouth, neck, axillae, hands; < 10 sq cm" 140401 CDM 521 RC 14040 HCPCS facility both 1345 1345 Gross Charge Type: NIHD_RHC_Price "14040 Adjacent tissue transfer; forehead, cheeks, chin, mouth, neck, axillae, hands; < 10 sq cm" 140401 CDM 521 RC 14040 HCPCS facility both 1345 1345 Gross Charge Type: NIHD_Clinic_Price "14040 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLA ProFee" 140402 CDM 982 RC 14040 HCPCS facility both 1103 1103 Gross Charge Type: NIHD_Hosp_Profee_Price "14040 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLA ProFee" 140402 CDM 982 RC 14040 HCPCS facility both 1103 1103 Gross Charge Type: NIHD_Hosp_Profee_Price "14041 Adjacent tissue transfer; forehead, cheeks, chin, mouth, neck, axillae, hands; 10.1-30.0 sq cm" 140411 CDM 521 RC 14041 HCPCS facility both 1644 1644 Gross Charge Type: NIHD_RHC_Price "14041 Adjacent tissue transfer; forehead, cheeks, chin, mouth, neck, axillae, hands; 10.1-30.0 sq cm" 140411 CDM 521 RC 14041 HCPCS facility both 1644 1644 Gross Charge Type: NIHD_Clinic_Price "14041 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLA ProFee" 140412 CDM 982 RC 14041 HCPCS facility both 1351 1351 Gross Charge Type: NIHD_Hosp_Profee_Price "14041 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLA ProFee" 140412 CDM 982 RC 14041 HCPCS facility both 1351 1351 Gross Charge Type: NIHD_Hosp_Profee_Price "14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; <10 sq cm" 140601 CDM 521 RC 14060 HCPCS facility both 1365 1365 Gross Charge Type: NIHD_RHC_Price "14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; <10 sq cm" 140601 CDM 521 RC 14060 HCPCS facility both 1365 1365 Gross Charge Type: NIHD_Clinic_Price "14060 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 ProFee" 140602 CDM 982 RC 14060 HCPCS facility both 1176 1176 Gross Charge Type: NIHD_Hosp_Profee_Price "14060 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 ProFee" 140602 CDM 982 RC 14060 HCPCS facility both 1176 1176 Gross Charge Type: NIHD_Hosp_Profee_Price "14061 Adj tissue transfer/rearrangement, eyelids/nose/ears and/or lips; defect 10.1 to 30.0 sq cm" 140611 CDM 521 RC 14061 HCPCS facility both 1770 1770 Gross Charge Type: NIHD_RHC_Price "14061 Adj tissue transfer/rearrangement, eyelids/nose/ears and/or lips; defect 10.1 to 30.0 sq cm" 140611 CDM 521 RC 14061 HCPCS facility both 1770 1770 Gross Charge Type: NIHD_Clinic_Price "14061 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10. ProFee" 140612 CDM 982 RC 14061 HCPCS facility both 1449 1449 Gross Charge Type: NIHD_Hosp_Profee_Price "14061 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10. ProFee" 140612 CDM 982 RC 14061 HCPCS facility both 1449 1449 Gross Charge Type: NIHD_Hosp_Profee_Price "14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm" 143011 CDM 521 RC 14301 HCPCS facility both 1912 1912 Gross Charge Type: NIHD_RHC_Price "14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm" 143011 CDM 521 RC 14301 HCPCS facility both 1912 1912 Gross Charge Type: NIHD_Clinic_Price "14301 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM ProFee" 143012 CDM 982 RC 14301 HCPCS facility both 1532 1532 Gross Charge Type: NIHD_Hosp_Profee_Price "14301 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM ProFee" 143012 CDM 982 RC 14301 HCPCS facility both 1532 1532 Gross Charge Type: NIHD_Hosp_Profee_Price "14302 Adjacent tissue transfer or rearrangement, any area; each addtnl 30.0 sq cm, or part thereof" 143021 CDM 521 RC 14302 HCPCS facility both 381 381 Gross Charge Type: NIHD_RHC_Price "14302 Adjacent tissue transfer or rearrangement, any area; each addtnl 30.0 sq cm, or part thereof" 143021 CDM 521 RC 14302 HCPCS facility both 381 381 Gross Charge Type: NIHD_Clinic_Price "14302 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PA ProFee" 143022 CDM 982 RC 14302 HCPCS facility both 381 381 Gross Charge Type: NIHD_Hosp_Profee_Price "14302 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PA ProFee" 143022 CDM 982 RC 14302 HCPCS facility both 381 381 Gross Charge Type: NIHD_Hosp_Profee_Price "15100 SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY A ProFee" 15100 CDM 982 RC 15100 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "15100 SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY A ProFee" 15100 CDM 982 RC 15100 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETENE 15X10CM 1510252 CDM 278 RC facility both 559 559 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETENE 15X10CM 1510252 CDM 278 RC facility both 559 559 Gross Charge Type: NIHD_Hosp_Profee_Price "15200 Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less" 152001 CDM 521 RC 15200 HCPCS facility both 1483 1483 Gross Charge Type: NIHD_RHC_Price "15200 Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less" 152001 CDM 521 RC 15200 HCPCS facility both 1483 1483 Gross Charge Type: NIHD_Clinic_Price "15200 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; 20 SQ CM OR ProFee" 152002 CDM 982 RC 15200 HCPCS facility both 1182 1182 Gross Charge Type: NIHD_Hosp_Profee_Price "15200 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; 20 SQ CM OR ProFee" 152002 CDM 982 RC 15200 HCPCS facility both 1182 1182 Gross Charge Type: NIHD_Hosp_Profee_Price "15201 Full thickness graft, free, including direct closure of donor site, trunk; ea addtnl 20 sq cm" 152011 CDM 521 RC 15201 HCPCS facility both 263 263 Gross Charge Type: NIHD_RHC_Price "15201 Full thickness graft, free, including direct closure of donor site, trunk; ea addtnl 20 sq cm" 152011 CDM 521 RC 15201 HCPCS facility both 263 263 Gross Charge Type: NIHD_Clinic_Price "15201 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; EACH ADDITI ProFee" 152012 CDM 982 RC 15201 HCPCS facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price "15201 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; EACH ADDITI ProFee" 152012 CDM 982 RC 15201 HCPCS facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price "15220 Full thickness graft, free, including direct closure of donor site, scalp/arms/legs; <20 sq cm" 152201 CDM 521 RC 15220 HCPCS facility both 1370 1370 Gross Charge Type: NIHD_RHC_Price "15220 Full thickness graft, free, including direct closure of donor site, scalp/arms/legs; <20 sq cm" 152201 CDM 521 RC 15220 HCPCS facility both 1370 1370 Gross Charge Type: NIHD_Clinic_Price "15220 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/O ProFee" 152202 CDM 982 RC 15220 HCPCS facility both 1034 1034 Gross Charge Type: NIHD_Hosp_Profee_Price "15220 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/O ProFee" 152202 CDM 982 RC 15220 HCPCS facility both 1034 1034 Gross Charge Type: NIHD_Hosp_Profee_Price "15221 Full thickness graft, free, including closure of donor site, scalp/arms/legs; ea addl 20 sq cm" 152211 CDM 521 RC 15221 HCPCS facility both 243 243 Gross Charge Type: NIHD_RHC_Price "15221 Full thickness graft, free, including closure of donor site, scalp/arms/legs; ea addl 20 sq cm" 152211 CDM 521 RC 15221 HCPCS facility both 243 243 Gross Charge Type: NIHD_Clinic_Price "15221 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/O ProFee" 152212 CDM 982 RC 15221 HCPCS facility both 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price "15221 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/O ProFee" 152212 CDM 982 RC 15221 HCPCS facility both 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price "15240 Full thickness graft, free; forehead, cheeks, chin, mouth, neck, axillae, hands; <20 sq cm" 152401 CDM 521 RC 15240 HCPCS facility both 1653 1653 Gross Charge Type: NIHD_RHC_Price "15240 Full thickness graft, free; forehead, cheeks, chin, mouth, neck, axillae, hands; <20 sq cm" 152401 CDM 521 RC 15240 HCPCS facility both 1653 1653 Gross Charge Type: NIHD_Clinic_Price "15240 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, ProFee" 152402 CDM 982 RC 15240 HCPCS facility both 1407 1407 Gross Charge Type: NIHD_Hosp_Profee_Price "15240 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, ProFee" 152402 CDM 982 RC 15240 HCPCS facility both 1407 1407 Gross Charge Type: NIHD_Hosp_Profee_Price 15241 Full thickness graft; forehead/cheeks/chin/mouth/neck/axil/gen/hands/feet; ea add 20 sq cm 152411 CDM 521 RC 15241 HCPCS facility both 322 322 Gross Charge Type: NIHD_RHC_Price 15241 Full thickness graft; forehead/cheeks/chin/mouth/neck/axil/gen/hands/feet; ea add 20 sq cm 152411 CDM 521 RC 15241 HCPCS facility both 322 322 Gross Charge Type: NIHD_Clinic_Price "15241 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, ProFee" 152412 CDM 982 RC 15241 HCPCS facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price "15241 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, ProFee" 152412 CDM 982 RC 15241 HCPCS facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price "15260 Full thickness graft, free, direct closure of donor site, nose/ears/eyelids/lips; <20 sq cm" 152601 CDM 521 RC 15260 HCPCS facility both 1780 1780 Gross Charge Type: NIHD_RHC_Price "15260 Full thickness graft, free, direct closure of donor site, nose/ears/eyelids/lips; <20 sq cm" 152601 CDM 521 RC 15260 HCPCS facility both 1780 1780 Gross Charge Type: NIHD_Clinic_Price "15260 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELID ProFee" 152602 CDM 982 RC 15260 HCPCS facility both 1499 1499 Gross Charge Type: NIHD_Hosp_Profee_Price "15260 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELID ProFee" 152602 CDM 982 RC 15260 HCPCS facility both 1499 1499 Gross Charge Type: NIHD_Hosp_Profee_Price "15261 Full thickness graft, free, closure of donor site, nose/ears/eyelids/lips; ea add 20 sq cm" 152611 CDM 521 RC 15261 HCPCS facility both 374 374 Gross Charge Type: NIHD_RHC_Price "15261 Full thickness graft, free, closure of donor site, nose/ears/eyelids/lips; ea add 20 sq cm" 152611 CDM 521 RC 15261 HCPCS facility both 374 374 Gross Charge Type: NIHD_Clinic_Price "15261 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELID ProFee" 152612 CDM 982 RC 15261 HCPCS facility both 243 243 Gross Charge Type: NIHD_Hosp_Profee_Price "15261 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELID ProFee" 152612 CDM 982 RC 15261 HCPCS facility both 243 243 Gross Charge Type: NIHD_Hosp_Profee_Price 15271 APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1 CHARGE 15271 CDM 761 RC facility both 2863 2863 Gross Charge Type: NIHD_Hosp_Profee_Price 15271 APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1 CHARGE 15271 CDM 761 RC facility both 2863 2863 Gross Charge Type: NIHD_Hosp_Profee_Price "15271 Application of skin graft to trunk/arms/legs, up to 100 sq cm; first 25 sq cm" 152711 CDM 521 RC 15271 HCPCS facility both 176 176 Gross Charge Type: NIHD_Clinic_Price "15271 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP ProFee" 152712 CDM 982 RC 15271 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price "15271 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP ProFee" 152712 CDM 982 RC 15271 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price "15272 Application of skin graft to trunk,arms,legs, up to 100 sq cm; ea add 25 sq cm" 15272 CDM 361 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price "15272 Application of skin graft to trunk,arms,legs, up to 100 sq cm; ea add 25 sq cm" 15272 CDM 361 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price "15272 Application of skin graft to trunk/arms/legs, up to 100 sq cm; ea add 25 sq cm" 152721 CDM 521 RC 15272 HCPCS facility both 114 114 Gross Charge Type: NIHD_Clinic_Price "15272 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP ProFee" 152722 CDM 982 RC 15272 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price "15272 APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP ProFee" 152722 CDM 982 RC 15272 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price 15273 APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST CHARGE 15273 CDM 761 RC facility both 4032 4032 Gross Charge Type: NIHD_Hosp_Profee_Price 15273 APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST CHARGE 15273 CDM 761 RC facility both 4032 4032 Gross Charge Type: NIHD_Hosp_Profee_Price "15273 — Application of skin substitute graft, first 100 sq cm wound surface area" 152732 CDM 982 RC 15273 HCPCS facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price "15273 — Application of skin substitute graft, first 100 sq cm wound surface area" 152732 CDM 982 RC 15273 HCPCS facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price "15274 Application of skin substiture graft, trunk, arms, legs, total wound surface area, ea add'l 10" 15274 CDM 761 RC facility both 1892 1892 Gross Charge Type: NIHD_Hosp_Profee_Price "15274 Application of skin substiture graft, trunk, arms, legs, total wound surface area, ea add'l 10" 15274 CDM 761 RC facility both 1892 1892 Gross Charge Type: NIHD_Hosp_Profee_Price "15274 — Each additional 100 sq cm wound surface area, or part thereof (list separately in addition t" 152742 CDM 982 RC 15274 HCPCS facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price "15274 — Each additional 100 sq cm wound surface area, or part thereof (list separately in addition t" 152742 CDM 982 RC 15274 HCPCS facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 15275 APP SKN SUB GRFT F/S/N/H/F/G/M/D <100SQ CHARGE 15275 CDM 361 RC facility both 3198 3198 Gross Charge Type: NIHD_Hosp_Profee_Price 15275 APP SKN SUB GRFT F/S/N/H/F/G/M/D <100SQ CHARGE 15275 CDM 361 RC facility both 3198 3198 Gross Charge Type: NIHD_Hosp_Profee_Price "15275 APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE,SCALP,EYELIDS,MOUTH,NECK,EARS,ORBITS,GENIT ProFee" 152751 CDM 982 RC 15275 HCPCS facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price "15275 APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE,SCALP,EYELIDS,MOUTH,NECK,EARS,ORBITS,GENIT ProFee" 152751 CDM 982 RC 15275 HCPCS facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price "15276 APPLY SKIN SUB - FEET, EACH ADD 25 SQ CM Wound" 15276 CDM 361 RC facility both 1411 1411 Gross Charge Type: NIHD_Hosp_Profee_Price "15276 APPLY SKIN SUB - FEET, EACH ADD 25 SQ CM Wound" 15276 CDM 361 RC facility both 1411 1411 Gross Charge Type: NIHD_Hosp_Profee_Price "15276 APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBIT ProFee" 152761 CDM 982 RC 15276 HCPCS facility both 38 38 Gross Charge Type: NIHD_Hosp_Profee_Price "15276 APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBIT ProFee" 152761 CDM 982 RC 15276 HCPCS facility both 38 38 Gross Charge Type: NIHD_Hosp_Profee_Price "15277 Application of skin substitute graft, face, scalp, eyelids, mouth, neck, ears, orbits, genital" 15277 CDM 761 RC facility both 3388 3388 Gross Charge Type: NIHD_Hosp_Profee_Price "15277 Application of skin substitute graft, face, scalp, eyelids, mouth, neck, ears, orbits, genital" 15277 CDM 761 RC facility both 3388 3388 Gross Charge Type: NIHD_Hosp_Profee_Price "15277 — Application of skin substitute graft, first 100 sq cm wound surface area" 152771 CDM 982 RC 15277 HCPCS facility both 671 671 Gross Charge Type: NIHD_Hosp_Profee_Price "15277 — Application of skin substitute graft, first 100 sq cm wound surface area" 152771 CDM 982 RC 15277 HCPCS facility both 671 671 Gross Charge Type: NIHD_Hosp_Profee_Price "15278 Application of skin substitute graft, face, scalp, eyelids, mouth, neck, ears, orbits, genital" 15278 CDM 761 RC facility both 3992 3992 Gross Charge Type: NIHD_Hosp_Profee_Price "15278 Application of skin substitute graft, face, scalp, eyelids, mouth, neck, ears, orbits, genital" 15278 CDM 761 RC facility both 3992 3992 Gross Charge Type: NIHD_Hosp_Profee_Price "15278 — Each additional 100 sq cm wound surface area, or part thereof (list separately in addition t" 152781 CDM 982 RC 15278 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price "15278 — Each additional 100 sq cm wound surface area, or part thereof (list separately in addition t" 152781 CDM 982 RC 15278 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price "15630 Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips" 156301 CDM 521 RC 15630 HCPCS facility both 820 820 Gross Charge Type: NIHD_RHC_Price "15630 Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips" 156301 CDM 521 RC 15630 HCPCS facility both 820 820 Gross Charge Type: NIHD_Clinic_Price "15630 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR L ProFee" 156302 CDM 982 RC 15630 HCPCS facility both 608 608 Gross Charge Type: NIHD_Hosp_Profee_Price "15630 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR L ProFee" 156302 CDM 982 RC 15630 HCPCS facility both 608 608 Gross Charge Type: NIHD_Hosp_Profee_Price 15731 Forehead flap with preservation of vascular pedicle 157311 CDM 521 RC 15731 HCPCS facility both 1980 1980 Gross Charge Type: NIHD_RHC_Price 15731 Forehead flap with preservation of vascular pedicle 157311 CDM 521 RC 15731 HCPCS facility both 1980 1980 Gross Charge Type: NIHD_Clinic_Price "15731 FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PARAMEDIA ProFee" 157312 CDM 982 RC 15731 HCPCS facility both 1758 1758 Gross Charge Type: NIHD_Hosp_Profee_Price "15731 FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PARAMEDIA ProFee" 157312 CDM 982 RC 15731 HCPCS facility both 1758 1758 Gross Charge Type: NIHD_Hosp_Profee_Price "15738 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY ProFee" 15738 CDM 982 RC 15738 HCPCS facility both 2278 2278 Gross Charge Type: NIHD_Hosp_Profee_Price "15738 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY ProFee" 15738 CDM 982 RC 15738 HCPCS facility both 2278 2278 Gross Charge Type: NIHD_Hosp_Profee_Price "15777 IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFOR ProFee" 15777 CDM 982 RC 15777 HCPCS facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price "15777 IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFOR ProFee" 15777 CDM 982 RC 15777 HCPCS facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price "15822 BLEPHAROPLASTY, UPPER EYELID; ProFee" 15822 CDM 09820981 RC 15822 HCPCS facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price "15822 BLEPHAROPLASTY, UPPER EYELID; ProFee" 15822 CDM 09820981 RC 15822 HCPCS facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price "15830 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAU ProFee" 15830 CDM 982 RC 15830 HCPCS facility both 2060 2060 Gross Charge Type: NIHD_Hosp_Profee_Price "15830 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAU ProFee" 15830 CDM 982 RC 15830 HCPCS facility both 2060 2060 Gross Charge Type: NIHD_Hosp_Profee_Price "15839 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); OTHER AREA ProFee" 15839 CDM 982 RC 15839 HCPCS facility both 1293 1293 Gross Charge Type: NIHD_Hosp_Profee_Price "15839 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); OTHER AREA ProFee" 15839 CDM 982 RC 15839 HCPCS facility both 1293 1293 Gross Charge Type: NIHD_Hosp_Profee_Price "15851 REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), OTHER SURGEON ProFee" 15851 CDM 982 RC 15851 HCPCS facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price "15851 REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), OTHER SURGEON ProFee" 15851 CDM 982 RC 15851 HCPCS facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price 15852 DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANESTHESIA (OTHER THAN LOCAL) ProFee 15852 CDM 982 RC 15852 HCPCS facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 15852 DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANESTHESIA (OTHER THAN LOCAL) ProFee 15852 CDM 982 RC 15852 HCPCS facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price "15853, Removal of sutures or staples not requiring anesthesia" 15853 CDM 521 RC 15853 HCPCS facility both 19 19 Gross Charge Type: NIHD_RHC_Price "15853, Removal of sutures or staples not requiring anesthesia" 15853 CDM 521 RC 15853 HCPCS facility both 19 19 Gross Charge Type: NIHD_Clinic_Price 16000 INITIAL TX 1ST DEGREE BURN LOCAL TX ProFee 16000 CDM 982 RC 16000 HCPCS facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price 16000 INITIAL TX 1ST DEGREE BURN LOCAL TX ProFee 16000 CDM 982 RC 16000 HCPCS facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price 16000 INITIAL TX 1ST DEGREE BURN LOCAL TX TechFee 160001 CDM 450 RC facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price 16000 INITIAL TX 1ST DEGREE BURN LOCAL TX TechFee 160001 CDM 450 RC facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price 16000 BURN CARE 1ST DEGREE CHARGE 160002 CDM 761 RC facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price 16000 BURN CARE 1ST DEGREE CHARGE 160002 CDM 761 RC facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price "16020 Dressings and/or debridement of partial-thickness burns, initial or subsequent; small" 160201 CDM 521 RC 16020 HCPCS facility both 205 205 Gross Charge Type: NIHD_RHC_Price "16020 Dressings and/or debridement of partial-thickness burns, initial or subsequent; small" 160201 CDM 521 RC 16020 HCPCS facility both 284 284 Gross Charge Type: NIHD_Clinic_Price 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL TechFee 160202 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL TechFee 160202 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "16020 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; SMALL ProFee" 160203 CDM 982 RC 16020 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "16020 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; SMALL ProFee" 160203 CDM 982 RC 16020 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 16020 BURN CARE SMALL <5% CHARGE 160204 CDM 761 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 16020 BURN CARE SMALL <5% CHARGE 160204 CDM 761 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "16025 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; MEDIUM ProFee" 16025 CDM 982 RC 16025 HCPCS facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price "16025 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; MEDIUM ProFee" 16025 CDM 982 RC 16025 HCPCS facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price 16025 BURN CARE 5-10% TBSA CHARGE 160251 CDM 761 RC facility both 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price 16025 BURN CARE 5-10% TBSA CHARGE 160251 CDM 761 RC facility both 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price "16030 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; LARGE ProFee" 16030 CDM 982 RC 16030 HCPCS facility both 794 794 Gross Charge Type: NIHD_Hosp_Profee_Price "16030 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; LARGE ProFee" 16030 CDM 982 RC 16030 HCPCS facility both 794 794 Gross Charge Type: NIHD_Hosp_Profee_Price "16030 Debride/dressing partial thickness burn,large-WC Charge" 160301 CDM 761 RC facility both 787 787 Gross Charge Type: NIHD_Hosp_Profee_Price "16030 Debride/dressing partial thickness burn,large-WC Charge" 160301 CDM 761 RC facility both 787 787 Gross Charge Type: NIHD_Hosp_Profee_Price 16035 Escharotomy; initial incision 160351 CDM 521 RC 16035 HCPCS facility both 389 389 Gross Charge Type: NIHD_Clinic_Price 16035 ESCHAROTOMY; INITIAL INCISION ProFee 160352 CDM 982 RC 16035 HCPCS facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 16035 ESCHAROTOMY; INITIAL INCISION ProFee 160352 CDM 982 RC 16035 HCPCS facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 16035 ESCHAROTOMY FIRST INCISION 160353 CDM 761 RC facility both 548 548 Gross Charge Type: NIHD_Hosp_Profee_Price 16035 ESCHAROTOMY FIRST INCISION 160353 CDM 761 RC facility both 548 548 Gross Charge Type: NIHD_Hosp_Profee_Price Rheumatoid Arthritis Profile LC 164065 CDM 300 RC facility both 12.16 12.16 Gross Charge Type: NIHD_Hosp_Profee_Price Rheumatoid Arthritis Profile LC 164065 CDM 300 RC facility both 12.16 12.16 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT KNEE UNIVERSAL 24 INCH 1668329 CDM 274 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT KNEE UNIVERSAL 24 INCH 1668329 CDM 274 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT KNEE UNIVERSAL 20 INCH 1668339 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT KNEE UNIVERSAL 20 INCH 1668339 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT UNIVERSAL KNEE 16 INCH 1668349 CDM 271 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT UNIVERSAL KNEE 16 INCH 1668349 CDM 271 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price "17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettemen" 17000 CDM 521 RC 17000 HCPCS facility both 217 217 Gross Charge Type: NIHD_RHC_Price "17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettemen" 17000 CDM 521 RC 17000 HCPCS facility both 157 157 Gross Charge Type: NIHD_Clinic_Price "17003 Destruction, premalignant lesions; second through 14 lesions, each" 17003 CDM 521 RC 17003 HCPCS facility both 50 50 Gross Charge Type: NIHD_RHC_Price "17003 Destruction, premalignant lesions; second through 14 lesions, each" 17003 CDM 521 RC 17003 HCPCS facility both 56 56 Gross Charge Type: NIHD_Clinic_Price "17004 Destruction, premalignant lesions, 15 or more lesions" 17004 CDM 521 RC 17004 HCPCS facility both 998 998 Gross Charge Type: NIHD_RHC_Price "17004 Destruction, premalignant lesions, 15 or more lesions" 17004 CDM 521 RC 17004 HCPCS facility both 998 998 Gross Charge Type: NIHD_Clinic_Price DESTRCT BNGN LESIONS UP TO 14 17110 CDM 521 RC 17110 HCPCS facility both 198 198 Gross Charge Type: NIHD_RHC_Price DESTRCT BNGN LESIONS UP TO 14 17110 CDM 521 RC 17110 HCPCS facility both 194 194 Gross Charge Type: NIHD_Clinic_Price 17110 DESTROY BENIGN LESION 1-14 CHARGE 171101 CDM 761 RC facility both 241 241 Gross Charge Type: NIHD_Hosp_Profee_Price 17110 DESTROY BENIGN LESION 1-14 CHARGE 171101 CDM 761 RC facility both 241 241 Gross Charge Type: NIHD_Hosp_Profee_Price "17110 Destruction, benign lesions other than skin tags, up to 14 lesions" 171102 CDM 982 RC 17110 HCPCS facility both 222 222 Gross Charge Type: NIHD_Hosp_Profee_Price "17110 Destruction, benign lesions other than skin tags, up to 14 lesions" 171102 CDM 982 RC 17110 HCPCS facility both 222 222 Gross Charge Type: NIHD_Hosp_Profee_Price 17111 Destruction of benign lesions; 15 + lesions 17111 CDM 521 RC 17111 HCPCS facility both 202 202 Gross Charge Type: NIHD_RHC_Price 17111 Destruction of benign lesions; 15 + lesions 17111 CDM 521 RC 17111 HCPCS facility both 203 203 Gross Charge Type: NIHD_Clinic_Price "17250 Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)" 172501 CDM 521 RC 17250 HCPCS facility both 68 68 Gross Charge Type: NIHD_RHC_Price "17250 Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)" 172501 CDM 521 RC 17250 HCPCS facility both 69 69 Gross Charge Type: NIHD_Clinic_Price "17250 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD FLESH, SINUS OR FISTULA) ProFee" 172502 CDM 982 RC 17250 HCPCS facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price "17250 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD FLESH, SINUS OR FISTULA) ProFee" 172502 CDM 982 RC 17250 HCPCS facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 17250 CHEMICAL CAUTERY GRANULATION TISSUE CHARGE 172503 CDM 761 RC facility both 493 493 Gross Charge Type: NIHD_Hosp_Profee_Price 17250 CHEMICAL CAUTERY GRANULATION TISSUE CHARGE 172503 CDM 761 RC facility both 493 493 Gross Charge Type: NIHD_Hosp_Profee_Price "17260 Destruction malignant lesion trunk, arms, legs; lesion diameter 0.5cm or less" 17260 CDM 521 RC 17260 HCPCS facility both 179 179 Gross Charge Type: NIHD_RHC_Price "17260 Destruction malignant lesion trunk, arms, legs; lesion diameter 0.5cm or less" 17260 CDM 521 RC 17260 HCPCS facility both 179 179 Gross Charge Type: NIHD_Clinic_Price "17261 Destruction, malignant lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm" 17261 CDM 521 RC 17261 HCPCS facility both 267 267 Gross Charge Type: NIHD_RHC_Price "17261 Destruction, malignant lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm" 17261 CDM 521 RC 17261 HCPCS facility both 267 267 Gross Charge Type: NIHD_Clinic_Price 17262 Lesion diameter 1.1 to 2.0cm 17262 CDM 521 RC 17262 HCPCS facility both 319 319 Gross Charge Type: NIHD_RHC_Price 17262 Lesion diameter 1.1 to 2.0cm 17262 CDM 521 RC 17262 HCPCS facility both 319 319 Gross Charge Type: NIHD_Clinic_Price "17263 Destruction, malignant lesion, trunk, arms or legs; lesion diameter 2.1 to 3.0 cm" 17263 CDM 521 RC 17263 HCPCS facility both 347 347 Gross Charge Type: NIHD_RHC_Price "17263 Destruction, malignant lesion, trunk, arms or legs; lesion diameter 2.1 to 3.0 cm" 17263 CDM 521 RC 17263 HCPCS facility both 347 347 Gross Charge Type: NIHD_Clinic_Price "17264 Destruction, malignant lesion, trunk, arms or legs; lesion diameter 3.1 to 4.0 cm" 17264 CDM 521 RC 17264 HCPCS facility both 371 371 Gross Charge Type: NIHD_RHC_Price "17264 Destruction, malignant lesion, trunk, arms or legs; lesion diameter 3.1 to 4.0 cm" 17264 CDM 521 RC 17264 HCPCS facility both 371 371 Gross Charge Type: NIHD_Clinic_Price "17280 Destruction, malignant lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion dm 0.5" 17280 CDM 521 RC 17280 HCPCS facility both 442 442 Gross Charge Type: NIHD_RHC_Price "17283 Destruction, malignant lesion, face, ears, eyelids, nose, lips, mucous; lesion diameter 2.1-3" 17283 CDM 521 RC 17283 HCPCS facility both 291 291 Gross Charge Type: NIHD_RHC_Price "17283 Destruction, malignant lesion, face, ears, eyelids, nose, lips, mucous; lesion diameter 2.1-3" 17283 CDM 521 RC 17283 HCPCS facility both 291 291 Gross Charge Type: NIHD_Clinic_Price 17999 Unlisted procedure skin MM & SQ tissue 17999 CDM 521 RC 17999 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_RHC_Price 17999 Unlisted procedure skin MM & SQ tissue 17999 CDM 521 RC 17999 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Clinic_Price "17999 UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE ProFee" 179991 CDM 982 RC 17999 HCPCS facility both 615 615 Gross Charge Type: NIHD_Hosp_Profee_Price "17999 UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE ProFee" 179991 CDM 982 RC 17999 HCPCS facility both 615 615 Gross Charge Type: NIHD_Hosp_Profee_Price levothyroxine 100 mcg (0.1 mg) Pow [INYO] 18539 CDM 63323-0649-07 NDC facility both 1 EA 1013.6 1013.6 Gross Charge Type: Pharmacy levothyroxine 100 mcg (0.1 mg) Pow [inyo] 18539 CDM 42023-0201-01 NDC facility both 1 EA 1013.6 1013.6 Gross Charge Type: Pharmacy levothyroxine 100 mcg (0.1 mg) Pow [INYO] 18539 CDM 70860-0451-10 NDC facility both 1 EA 907.2 907.2 Gross Charge Type: Pharmacy 19000 Puncture aspiration of cyst of breast 190001 CDM 521 RC 19000 HCPCS facility both 541 541 Gross Charge Type: NIHD_RHC_Price 19000 Puncture aspiration of cyst of breast 190001 CDM 521 RC 19000 HCPCS facility both 541 541 Gross Charge Type: NIHD_Clinic_Price 19000 PUNCTURE ASPIRATION OF CYST OF BREAST; ProFee 190002 CDM 982 RC 19000 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 19000 PUNCTURE ASPIRATION OF CYST OF BREAST; ProFee 190002 CDM 982 RC 19000 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Cyst Aspiration Left 190003 CDM 320 RC facility both TCLT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Cyst Aspiration Left 190003 CDM 320 RC facility both TCLT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Cyst Aspiration Left - Report 190004 CDM 972 RC 19000 HCPCS facility both 26LT 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Cyst Aspiration Left - Report 190004 CDM 972 RC 19000 HCPCS facility both 26LT 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Cyst Aspiration Right 190005 CDM 320 RC facility both TCRT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Cyst Aspiration Right 190005 CDM 320 RC facility both TCRT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Cyst Aspiration Right - Report 190006 CDM 972 RC 19000 HCPCS facility both 26RT 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Cyst Aspiration Right - Report 190006 CDM 972 RC 19000 HCPCS facility both 26RT 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 19000 US ASP BREAST CYST 190007 CDM 320 RC facility both TC50 1143 1143 Gross Charge Type: NIHD_Hosp_Profee_Price 19000 US ASP BREAST CYST 190007 CDM 320 RC facility both TC50 1143 1143 Gross Charge Type: NIHD_Hosp_Profee_Price "19020 Mastotomy with exploration or drainage of abscess, deep" 190201 CDM 521 RC 19020 HCPCS facility both 999 999 Gross Charge Type: NIHD_Clinic_Price "19020 MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP ProFee" 190202 CDM 982 RC 19020 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "19020 MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP ProFee" 190202 CDM 982 RC 19020 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Right. 19081 CDM 320 RC facility both TCRT 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Right. 19081 CDM 320 RC facility both TCRT 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Left 190811 CDM 320 RC facility both TCLT 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Left 190811 CDM 320 RC facility both TCLT 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Left - Report 190812 CDM 972 RC 19081 HCPCS facility both 26LT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Left - Report 190812 CDM 972 RC 19081 HCPCS facility both 26LT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Right 190813 CDM 320 RC facility both TCRT 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Right 190813 CDM 320 RC facility both TCRT 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Right - Report 190814 CDM 972 RC 19081 HCPCS facility both RT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Right - Report 190814 CDM 972 RC 19081 HCPCS facility both RT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Left. 190815 CDM 320 RC facility both TCLT 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Left. 190815 CDM 320 RC facility both TCLT 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Left. - Report 190816 CDM 972 RC 19081 HCPCS facility both 26LT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Left. - Report 190816 CDM 972 RC 19081 HCPCS facility both 26LT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Bilat 190817 CDM 320 RC facility both TC 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Bilat 190817 CDM 320 RC facility both TC 3562 3562 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Right. - Report 190818 CDM 972 RC 19081 HCPCS facility both 26RT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Right. - Report 190818 CDM 972 RC 19081 HCPCS facility both 26RT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Bilat - Report 190819 CDM 972 RC 19081 HCPCS facility both 2650 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Biopsy w/ Stereo Guide Bilat - Report 190819 CDM 972 RC 19081 HCPCS facility both 2650 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Biopsy Left 190831 CDM 402 RC facility both TCLT 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Biopsy Left 190831 CDM 402 RC facility both TCLT 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Biopsy Left - Report 190832 CDM 972 RC 19083 HCPCS facility both LT 1536 1536 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Biopsy Left - Report 190832 CDM 972 RC 19083 HCPCS facility both LT 1536 1536 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Breast Biopsy Core Left 190833 CDM 402 RC facility both TCLT 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Breast Biopsy Core Left 190833 CDM 402 RC facility both TCLT 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Breast Biopsy Core Right 190835 CDM 402 RC facility both TCRT 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Breast Biopsy Core Right 190835 CDM 402 RC facility both TCRT 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Biopsy Right 190837 CDM 402 RC facility both RT 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Biopsy Right 190837 CDM 402 RC facility both RT 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Biopsy Right - Report 190838 CDM 972 RC 19083 HCPCS facility both RT 1536 1536 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Biopsy Right - Report 190838 CDM 972 RC 19083 HCPCS facility both RT 1536 1536 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US BREAST BIPOSY EA ADDL LESION 19084 CDM 402 RC facility both 2612 2612 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US BREAST BIPOSY EA ADDL LESION 19084 CDM 402 RC facility both 2612 2612 Gross Charge Type: NIHD_Hosp_Profee_Price 19084 NIHD US BREAST BIPOSY EA ADDL LESION 190841 CDM 402 RC facility both 2736 2736 Gross Charge Type: NIHD_Hosp_Profee_Price 19084 NIHD US BREAST BIPOSY EA ADDL LESION 190841 CDM 402 RC facility both 2736 2736 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast Biopsy w/ MRI Guide Left. 190851 CDM 320 RC facility both TCLT 5501 5501 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast Biopsy w/ MRI Guide Left. 190851 CDM 320 RC facility both TCLT 5501 5501 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast Biopsy w/ MRI Guide Right. 190853 CDM 320 RC facility both TCRT 5501 5501 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast Biopsy w/ MRI Guide Right. 190853 CDM 320 RC facility both TCRT 5501 5501 Gross Charge Type: NIHD_Hosp_Profee_Price "19101 BIOPSY OF BREAST; OPEN, INCISIONAL ProFee" 19101 CDM 982 RC 19101 HCPCS facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price "19101 BIOPSY OF BREAST; OPEN, INCISIONAL ProFee" 19101 CDM 982 RC 19101 HCPCS facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price "19110 NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A PAPIL ProFee" 19110 CDM 982 RC 19110 HCPCS facility both 673 673 Gross Charge Type: NIHD_Hosp_Profee_Price "19110 NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A PAPIL ProFee" 19110 CDM 982 RC 19110 HCPCS facility both 673 673 Gross Charge Type: NIHD_Hosp_Profee_Price "19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue" 191202 CDM 521 RC 19120 HCPCS facility both 812 812 Gross Charge Type: NIHD_Clinic_Price "19120 EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TI ProFee" 191203 CDM 982 RC 19120 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price "19120 EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TI ProFee" 191203 CDM 982 RC 19120 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price "19125 EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER, ProFee" 19125 CDM 982 RC 19125 HCPCS facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "19125 EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER, ProFee" 19125 CDM 982 RC 19125 HCPCS facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "19281 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactiv" 192811 CDM 521 RC 19281 HCPCS facility both 207 207 Gross Charge Type: NIHD_Clinic_Price MG Device Plcmnt w/ Mammo Guide Right 1928110 CDM 320 RC facility both TCRT 2933 2933 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Right 1928110 CDM 320 RC facility both TCRT 2933 2933 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Bilat 1928111 CDM 320 RC facility both TC 2933 2933 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Bilat 1928111 CDM 320 RC facility both TC 2933 2933 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Bilat - Report 1928112 CDM 972 RC 19281 HCPCS facility both 2650 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Bilat - Report 1928112 CDM 972 RC 19281 HCPCS facility both 2650 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price "19281 PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RA ProFee" 192812 CDM 982 RC 19281 HCPCS facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price "19281 PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RA ProFee" 192812 CDM 982 RC 19281 HCPCS facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Left - Report 192817 CDM 972 RC 19281 HCPCS facility both 26LT 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Left - Report 192817 CDM 972 RC 19281 HCPCS facility both 26LT 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Right - Report 192818 CDM 972 RC 19281 HCPCS facility both 26RT 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Right - Report 192818 CDM 972 RC 19281 HCPCS facility both 26RT 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Left 192819 CDM 320 RC facility both TCLT 2933 2933 Gross Charge Type: NIHD_Hosp_Profee_Price MG Device Plcmnt w/ Mammo Guide Left 192819 CDM 320 RC facility both TCLT 2933 2933 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD MG BREAST WIRE LOC ADDL LESION 19284 CDM 320 RC facility both TC 3053 3053 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD MG BREAST WIRE LOC ADDL LESION 19284 CDM 320 RC facility both TC 3053 3053 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Left 192851 CDM 402 RC facility both TCLT 2409 2409 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Left 192851 CDM 402 RC facility both TCLT 2409 2409 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Left - Report 192852 CDM 972 RC 19285 HCPCS facility both 26LT 877 877 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Left - Report 192852 CDM 972 RC 19285 HCPCS facility both 26LT 877 877 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Right 192853 CDM 402 RC facility both TCRT 2409 2409 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Right 192853 CDM 402 RC facility both TCRT 2409 2409 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Right - Report 192854 CDM 972 RC 19285 HCPCS facility both 26RT 877 877 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Right - Report 192854 CDM 972 RC 19285 HCPCS facility both 26RT 877 877 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Bilat 192855 CDM 402 RC facility both TC 2409 2409 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Bilat 192855 CDM 402 RC facility both TC 2409 2409 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Bilat - Report 192856 CDM 972 RC 19285 HCPCS facility both 2650 877 877 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Device Plcmnt w/US Guide Bilat - Report 192856 CDM 972 RC 19285 HCPCS facility both 2650 877 877 Gross Charge Type: NIHD_Hosp_Profee_Price 19286 US Breast Needle Loc Unilateral Ea Addl 192863 CDM 761 RC facility both TC 1393 1393 Gross Charge Type: NIHD_Hosp_Profee_Price 19286 US Breast Needle Loc Unilateral Ea Addl 192863 CDM 761 RC facility both TC 1393 1393 Gross Charge Type: NIHD_Hosp_Profee_Price 19286 US Breast Needle Loc Unilateral Ea Addl PROFEE 192864 CDM 972 RC 19286 HCPCS facility both 26 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price 19286 US Breast Needle Loc Unilateral Ea Addl PROFEE 192864 CDM 972 RC 19286 HCPCS facility both 26 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price 19300 MASTECTOMY FOR GYNECOMASTIA ProFee 19300 CDM 19300 HCPCS facility both 659 659 Gross Charge Type: NIHD_Hosp_Profee_Price 19300 MASTECTOMY FOR GYNECOMASTIA ProFee 19300 CDM 19300 HCPCS facility both 659 659 Gross Charge Type: NIHD_Hosp_Profee_Price "19301 MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); ProFee" 19301 CDM 982 RC 19301 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "19301 MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); ProFee" 19301 CDM 982 RC 19301 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "19302 MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH A ProFee" 19302 CDM 982 RC 19302 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "19302 MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH A ProFee" 19302 CDM 982 RC 19302 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "19303 MASTECTOMY, SIMPLE, COMPLETE ProFee" 19303 CDM 982 RC 19303 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "19303 MASTECTOMY, SIMPLE, COMPLETE ProFee" 19303 CDM 982 RC 19303 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price 19305 ASST MAST RADICAL 19305 CDM 982 RC 19305 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 19305 ASST MAST RADICAL 19305 CDM 982 RC 19305 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "19307 MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORAL ProFee" 19307 CDM 982 RC 19307 HCPCS facility both 2372 2372 Gross Charge Type: NIHD_Hosp_Profee_Price "19307 MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORAL ProFee" 19307 CDM 982 RC 19307 HCPCS facility both 2372 2372 Gross Charge Type: NIHD_Hosp_Profee_Price 19316 ASST SUSPENSION OF BREAST 19316 CDM 982 RC 19316 HCPCS facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 19316 ASST SUSPENSION OF BREAST 19316 CDM 982 RC 19316 HCPCS facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 19318 REDUCTION MAMMAPLASTY ProFee 19318 CDM 982 RC 19318 HCPCS facility both 1928 1928 Gross Charge Type: NIHD_Hosp_Profee_Price 19318 REDUCTION MAMMAPLASTY ProFee 19318 CDM 982 RC 19318 HCPCS facility both 1928 1928 Gross Charge Type: NIHD_Hosp_Profee_Price "19340 IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONST ProFee" 19340 CDM 982 RC 19340 HCPCS facility both 1738 1738 Gross Charge Type: NIHD_Hosp_Profee_Price "19340 IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONST ProFee" 19340 CDM 982 RC 19340 HCPCS facility both 1738 1738 Gross Charge Type: NIHD_Hosp_Profee_Price 19350 NIPPLE/AREOLA RECONSTRUCTION ProFee 19350 CDM 982 RC 19350 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price 19350 NIPPLE/AREOLA RECONSTRUCTION ProFee 19350 CDM 982 RC 19350 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "19357 BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUE EXPANDER, INCLUDING SUBSEQUEN ProFee" 19357 CDM 982 RC 19357 HCPCS facility both 2665 2665 Gross Charge Type: NIHD_Hosp_Profee_Price "19357 BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUE EXPANDER, INCLUDING SUBSEQUEN ProFee" 19357 CDM 982 RC 19357 HCPCS facility both 2665 2665 Gross Charge Type: NIHD_Hosp_Profee_Price "19367 BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP (TRAM), SINGL ProFee" 19367 CDM 982 RC 19367 HCPCS facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price "19367 BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP (TRAM), SINGL ProFee" 19367 CDM 982 RC 19367 HCPCS facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price "19371 PERIPROSTHETIC CAPSULECTOMY, BREAST ProFee" 19371 CDM 982 RC 19371 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "19371 PERIPROSTHETIC CAPSULECTOMY, BREAST ProFee" 19371 CDM 982 RC 19371 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price 19380 REVISION OF RECONSTRUCTED BREAST ProFee 19380 CDM 982 RC 19380 HCPCS facility both 1365 1365 Gross Charge Type: NIHD_Hosp_Profee_Price 19380 REVISION OF RECONSTRUCTED BREAST ProFee 19380 CDM 982 RC 19380 HCPCS facility both 1365 1365 Gross Charge Type: NIHD_Hosp_Profee_Price 20102 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); ABDOMEN/FLANK/BACK ProFee 20102 CDM 975 RC 20102 HCPCS facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price 20102 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); ABDOMEN/FLANK/BACK ProFee 20102 CDM 975 RC 20102 HCPCS facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price 20103 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY ProFee 20103 CDM 982 RC 20103 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price 20103 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY ProFee 20103 CDM 982 RC 20103 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price pyridoxine 50 mg Tab [INYO] 20162 CDM 50268-0858-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pyridoxine 50 mg Tab [INYO] 20162 CDM 11845-0570-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pyridoxine 100 mg/mL Inj Sol [INYO] 20170 CDM J3415 HCPCS 63323-0180-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy CT Biopsy Muscle 202061 CDM 761 RC facility both TC 1414 1414 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Muscle 202061 CDM 761 RC facility both TC 1414 1414 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Muscle - Report 202062 CDM 972 RC 20206 HCPCS facility both 26 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Muscle - Report 202062 CDM 972 RC 20206 HCPCS facility both 26 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Muscle 202063 CDM 761 RC facility both TC 1414 1414 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Muscle 202063 CDM 761 RC facility both TC 1414 1414 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Muscle - Report 202064 CDM 972 RC 20206 HCPCS facility both 26 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Muscle - Report 202064 CDM 972 RC 20206 HCPCS facility both 26 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Bone Superficial 202202 CDM 761 RC facility both TC 2242 2242 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Bone Superficial 202202 CDM 761 RC facility both TC 2242 2242 Gross Charge Type: NIHD_Hosp_Profee_Price "20225 BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR) ProFee" 202251 CDM 982 RC 20225 HCPCS facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price "20225 BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (EG, VERTEBRAL BODY, FEMUR) ProFee" 202251 CDM 982 RC 20225 HCPCS facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Bone Deep - Report 202252 CDM 972 RC 20225 HCPCS facility both 26 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Bone Deep - Report 202252 CDM 972 RC 20225 HCPCS facility both 26 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Bone Deep 202253 CDM 761 RC facility both TC 2095 2095 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Bone Deep 202253 CDM 761 RC facility both TC 2095 2095 Gross Charge Type: NIHD_Hosp_Profee_Price "20240 BIOPSY, BONE, OPEN; SUPERFICIAL (EG, STERNUM, SPINOUS PROCESS, RIB, PATELLA, OLECRANON ProFee" 20240 CDM 982 RC 20240 HCPCS facility both 282 282 Gross Charge Type: NIHD_Hosp_Profee_Price "20240 BIOPSY, BONE, OPEN; SUPERFICIAL (EG, STERNUM, SPINOUS PROCESS, RIB, PATELLA, OLECRANON ProFee" 20240 CDM 982 RC 20240 HCPCS facility both 282 282 Gross Charge Type: NIHD_Hosp_Profee_Price "20245 BIOPSY, BONE, OPEN; DEEP (EG, HUMERAL SHAFT, ISCHIUM, FEMORAL SHAFT) ProFee" 20245 CDM 982 RC 20245 HCPCS facility both 1046 1046 Gross Charge Type: NIHD_Hosp_Profee_Price "20245 BIOPSY, BONE, OPEN; DEEP (EG, HUMERAL SHAFT, ISCHIUM, FEMORAL SHAFT) ProFee" 20245 CDM 982 RC 20245 HCPCS facility both 1046 1046 Gross Charge Type: NIHD_Hosp_Profee_Price "5.0X180MM - DRILL, AO, STERILE" 2025001 CDM 272 RC facility both 396 396 Gross Charge Type: NIHD_Hosp_Profee_Price "5.0X180MM - DRILL, AO, STERILE" 2025001 CDM 272 RC facility both 396 396 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 1.50X300 MM 2025002 CDM 278 RC facility both 947 947 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 1.50X300 MM 2025002 CDM 278 RC facility both 947 947 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 1.75X300 MM 2025003 CDM 278 RC facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 1.75X300 MM 2025003 CDM 278 RC facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 2.0X300 MM 2025004 CDM 278 RC facility both 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 2.0X300 MM 2025004 CDM 278 RC facility both 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 2.25X300 MM 2025005 CDM 278 RC facility both 1042 1042 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 2.25X300 MM 2025005 CDM 278 RC facility both 1042 1042 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 2.5X450 MM 2025006 CDM 278 RC facility both 1107 1107 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 2.5X450 MM 2025006 CDM 278 RC facility both 1107 1107 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 3.0X450 MM 2025007 CDM 278 RC facility both 1139 1139 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 3.0X450 MM 2025007 CDM 278 RC facility both 1139 1139 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 3.5X450 MM 2025008 CDM 278 RC facility both 1172 1172 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 3.5X450 MM 2025008 CDM 278 RC facility both 1172 1172 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 4.0X450 2025009 CDM 278 RC facility both 1206 1206 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIBLE NAIL PRE-CURVED 4.0X450 2025009 CDM 278 RC facility both 1206 1206 Gross Charge Type: NIHD_Hosp_Profee_Price STERILE MODIFIED HALL MODULAR SHAFT 450M 2025013 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price STERILE MODIFIED HALL MODULAR SHAFT 450M 2025013 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "REAMER SHAFT, MODIFIED TRINKLE, 8X510MM" 2025014 CDM 278 RC facility both 1026 1026 Gross Charge Type: NIHD_Hosp_Profee_Price "REAMER SHAFT, MODIFIED TRINKLE, 8X510MM" 2025014 CDM 278 RC facility both 1026 1026 Gross Charge Type: NIHD_Hosp_Profee_Price 0.045IN.(1.143MM)K-WIRE W/LENGTH MARKING 2025015 CDM 278 RC facility both 95 95 Gross Charge Type: NIHD_Hosp_Profee_Price 0.045IN.(1.143MM)K-WIRE W/LENGTH MARKING 2025015 CDM 278 RC facility both 95 95 Gross Charge Type: NIHD_Hosp_Profee_Price R HEAD NECK PLATE 2025016 CDM 278 RC facility both 3410 3410 Gross Charge Type: NIHD_Hosp_Profee_Price R HEAD NECK PLATE 2025016 CDM 278 RC facility both 3410 3410 Gross Charge Type: NIHD_Hosp_Profee_Price R HEAD SMALL RIM PLATE 2025017 CDM 278 RC facility both 3410 3410 Gross Charge Type: NIHD_Hosp_Profee_Price R HEAD SMALL RIM PLATE 2025017 CDM 278 RC facility both 3410 3410 Gross Charge Type: NIHD_Hosp_Profee_Price R HEAD STANDARD RIM PLATE 2025018 CDM 278 RC facility both 3410 3410 Gross Charge Type: NIHD_Hosp_Profee_Price R HEAD STANDARD RIM PLATE 2025018 CDM 278 RC facility both 3410 3410 Gross Charge Type: NIHD_Hosp_Profee_Price R HEAD LONG STANDARD RIM PLATE 2025019 CDM 278 RC facility both 3410 3410 Gross Charge Type: NIHD_Hosp_Profee_Price R HEAD LONG STANDARD RIM PLATE 2025019 CDM 278 RC facility both 3410 3410 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 3.2X450MM (STERILE) 2025020 CDM 272 RC facility both 291 291 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 3.2X450MM (STERILE) 2025020 CDM 272 RC facility both 291 291 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 4.2X300MM AO SMALL STERILE 2025022 CDM 272 RC facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 4.2X300MM AO SMALL STERILE 2025022 CDM 272 RC facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 10MM 2025023 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 10MM 2025023 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 11MM 2025024 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 11MM 2025024 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 12MM 2025025 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 12MM 2025025 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 13MM 2025026 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 13MM 2025026 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 14MM 2025027 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 14MM 2025027 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 15MM 2025028 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 15MM 2025028 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 16MM 2025029 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 16MM 2025029 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 17MM 2025030 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 17MM 2025030 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 18MM 2025031 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 18MM 2025031 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 19MM 2025032 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 19MM 2025032 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 20MM 2025033 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 20MM 2025033 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 21MM 2025034 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 21MM 2025034 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 22MM 2025035 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 22MM 2025035 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 23MM 2025036 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 23MM 2025036 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 24MM 2025037 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 24MM 2025037 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 25MM 2025038 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 25MM 2025038 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 26MM 2025039 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 26MM 2025039 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 27MM 2025040 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 27MM 2025040 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 28MM 2025041 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 28MM 2025041 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 29MM 2025042 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 29MM 2025042 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 30MM 2025043 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 30MM 2025043 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 10MM 2025044 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 10MM 2025044 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 11MM 2025045 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 11MM 2025045 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 12MM 2025046 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 12MM 2025046 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 13MM 2025047 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 13MM 2025047 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 14MM 2025048 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 14MM 2025048 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 15MM 2025049 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 15MM 2025049 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 16MM 2025050 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 16MM 2025050 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 17MM 2025051 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 17MM 2025051 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 18MM 2025052 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 18MM 2025052 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 19MM 2025053 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 19MM 2025053 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 20MM 2025054 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 20MM 2025054 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 21MM 2025055 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 21MM 2025055 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 22MM 2025056 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 22MM 2025056 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 23MM 2025057 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 23MM 2025057 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 24MM 2025058 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 24MM 2025058 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 25MM 2025059 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 25MM 2025059 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 26MM 2025060 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 26MM 2025060 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 27MM 2025061 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 27MM 2025061 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 28MM 2025062 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 28MM 2025062 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 29MM 2025063 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 29MM 2025063 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 30MM 2025064 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price AUTOFIX COMPR SCREW MOD T7 DR 2.5 X 30MM 2025064 CDM 278 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4 X 8 2025065 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4 X 8 2025065 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X10 2025066 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X10 2025066 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X12 2025067 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X12 2025067 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X14 2025068 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X14 2025068 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X16 2025069 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X16 2025069 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X18 2025070 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X18 2025070 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X20 2025071 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X20 2025071 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X22 2025072 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X22 2025072 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X24 2025073 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X24 2025073 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X26 2025074 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X26 2025074 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X28 2025075 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTEX SCREW SELF-TAPP MOD T7 DR 2.4X28 2025075 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 8MM 2025076 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 8MM 2025076 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 10MM 2025077 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 10MM 2025077 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 12MM 2025078 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 12MM 2025078 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 14MM 2025079 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 14MM 2025079 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 16MM 2025080 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 16MM 2025080 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 18MM 2025081 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 18MM 2025081 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 20MM 2025082 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 20MM 2025082 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 22MM 2025083 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 22MM 2025083 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 24MM 2025084 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 24MM 2025084 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 26MM 2025085 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 26MM 2025085 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 28MM 2025086 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price CORTICAL SCREW (MOD T7 DR) 2.7MM X 28MM 2025086 CDM 278 RC facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 8MM 2025087 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 8MM 2025087 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 10MM 2025088 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 10MM 2025088 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 12MM 2025089 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 12MM 2025089 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 14MM 2025090 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 14MM 2025090 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 16MM 2025091 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 16MM 2025091 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 18MM 2025092 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 18MM 2025092 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 20MM 2025093 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 20MM 2025093 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 22MM 2025094 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 22MM 2025094 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 24MM 2025095 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 24MM 2025095 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 26MM 2025096 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 26MM 2025096 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 28MM 2025097 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.4MM X 28MM 2025097 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.7MM X 8MM 2025098 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.7MM X 8MM 2025098 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.7MM X 10MM 2025099 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.7MM X 10MM 2025099 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.7MM X 12MM 2025101 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.7MM X 12MM 2025101 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.7MM X 14MM 2025102 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price FIXED ANGLE LOCKING SCREW 2.7MM X 14MM 2025102 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 16MM 2025103 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 16MM 2025103 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 18MM 2025104 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 18MM 2025104 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 20MM 2025105 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 20MM 2025105 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 22MM 2025106 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 22MM 2025106 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 24MM 2025107 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 24MM 2025107 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 26MM 2025108 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 26MM 2025108 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 28MM 2025109 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW SS 2.7 X 28MM 2025109 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE BALL TIP 3.0X800MM STERILE 2025110 CDM 272 RC facility both 423 423 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE BALL TIP 3.0X800MM STERILE 2025110 CDM 272 RC facility both 423 423 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE BALL TIP 3X1000 STERILE 2025112 CDM 272 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE BALL TIP 3X1000 STERILE 2025112 CDM 272 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price COUNTERSINK 1806-2016 2025114 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price COUNTERSINK 1806-2016 2025114 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.2X340MM AO STERILE 2025115 CDM 272 RC facility both 401 401 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.2X340MM AO STERILE 2025115 CDM 272 RC facility both 401 401 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 4.2X180MM AO SMALL STERILE 2025117 CDM 272 RC facility both 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 4.2X180MM AO SMALL STERILE 2025117 CDM 272 RC facility both 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.2X130MM AO STERILE 2025118 CDM 272 RC facility both 401 401 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.2X130MM AO STERILE 2025118 CDM 272 RC facility both 401 401 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 4.2X230MM AO SMALL STERILE 2025119 CDM 272 RC facility both 432 432 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 4.2X230MM AO SMALL STERILE 2025119 CDM 272 RC facility both 432 432 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 5.0X230MM AO STERILE 2025120 CDM 272 RC facility both 709 709 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 5.0X230MM AO STERILE 2025120 CDM 272 RC facility both 709 709 Gross Charge Type: NIHD_Hosp_Profee_Price T2 ADV COMP SCREW TIBIA 2025121 CDM 278 RC facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price T2 ADV COMP SCREW TIBIA 2025121 CDM 278 RC facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STANDARD END CAP - 8MM 2025122 CDM 278 RC facility both 434 434 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STANDARD END CAP - 8MM 2025122 CDM 278 RC facility both 434 434 Gross Charge Type: NIHD_Hosp_Profee_Price T2 +5MM END CAP 2025123 CDM 278 RC facility both 434 434 Gross Charge Type: NIHD_Hosp_Profee_Price T2 +5MM END CAP 2025123 CDM 278 RC facility both 434 434 Gross Charge Type: NIHD_Hosp_Profee_Price T2 +10MM END CAP 2025124 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 +10MM END CAP 2025124 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 +15MM END CAP 2025125 CDM 278 RC facility both 434 434 Gross Charge Type: NIHD_Hosp_Profee_Price T2 +15MM END CAP 2025125 CDM 278 RC facility both 434 434 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX270MM 2025126 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX270MM 2025126 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX285MM 2025127 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX285MM 2025127 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX300MM 2025128 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX300MM 2025128 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX315MM 2025129 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX315MM 2025129 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX330MM 2025130 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX330MM 2025130 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX345MM 2025131 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX345MM 2025131 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX360MM 2025132 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX360MM 2025132 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX375MM 2025133 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX375MM 2025133 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX390MM 2025134 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX390MM 2025134 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX405MM 2025135 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 9MMX405MM 2025135 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX270MM 2025136 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX270MM 2025136 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX285MM 2025137 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX285MM 2025137 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX300MM 2025138 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX300MM 2025138 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX315MM 2025139 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX315MM 2025139 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX330MM 2025140 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX330MM 2025140 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX345MM 2025141 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX345MM 2025141 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX360MM 2025142 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX360MM 2025142 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX375MM 2025143 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX375MM 2025143 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX390MM 2025144 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX390MM 2025144 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX405MM 2025145 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 10MMX405MM 2025145 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX270MM 2025146 CDM 278 RC facility both 7925 7925 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX270MM 2025146 CDM 278 RC facility both 7925 7925 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX285MM 2025147 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX285MM 2025147 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX300MM 2025148 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX300MM 2025148 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX315MM 2025149 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX315MM 2025149 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX330MM 2025150 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX330MM 2025150 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX345MM 2025151 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX345MM 2025151 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX360MM 2025152 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX360MM 2025152 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX375MM 2025153 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX375MM 2025153 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX390MM 2025154 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX390MM 2025154 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX405MM 2025155 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 11MMX405MM 2025155 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX270MM 2025156 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX270MM 2025156 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX285MM 2025157 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX285MM 2025157 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX300MM 2025158 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX300MM 2025158 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX315MM 2025159 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX315MM 2025159 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX330MM 2025160 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX330MM 2025160 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX345MM 2025161 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX345MM 2025161 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX360MM 2025162 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX360MM 2025162 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX375MM 2025163 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX375MM 2025163 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX390MM 2025164 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX390MM 2025164 CDM 278 RC facility both 5941 5941 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX405MM 2025165 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 STD. TIBIAL NAIL 12MMX405MM 2025165 CDM 278 RC facility both 3528 3528 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SCN FULLY THREADED END CAP 2025166 CDM 278 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SCN FULLY THREADED END CAP 2025166 CDM 278 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X170MM 2025168 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X170MM 2025168 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X200MM 2025169 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X200MM 2025169 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X300MM 2025170 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X300MM 2025170 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X320MM 2025171 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X320MM 2025171 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X340MM 2025172 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X340MM 2025172 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X360MM 2025173 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X360MM 2025173 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X380MM 2025174 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X380MM 2025174 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X400MM 2025175 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X400MM 2025175 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X420MM 2025176 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 10X420MM 2025176 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X170MM 2025177 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X170MM 2025177 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X200MM 2025178 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X200MM 2025178 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X300MM 2025179 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X300MM 2025179 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X320MM 2025180 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X320MM 2025180 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X340MM 2025181 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X340MM 2025181 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X360MM 2025182 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X360MM 2025182 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X380MM 2025183 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X380MM 2025183 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X400MM 2025184 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X400MM 2025184 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X420MM 2025185 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 11X420MM 2025185 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X170MM 2025186 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X170MM 2025186 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X200MM 2025187 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X200MM 2025187 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X300MM 2025188 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X300MM 2025188 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X320MM 2025189 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X320MM 2025189 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X340MM 2025190 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X340MM 2025190 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X360MM 2025191 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X360MM 2025191 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X380MM 2025192 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X380MM 2025192 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X400MM 2025193 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X400MM 2025193 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X420MM 2025194 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 12X420MM 2025194 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X170MM 2025195 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X170MM 2025195 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X200MM 2025196 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X200MM 2025196 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X300MM 2025197 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X300MM 2025197 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X320MM 2025198 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X320MM 2025198 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X340MM 2025199 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X340MM 2025199 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X360MM 2025200 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X360MM 2025200 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X380MM 2025201 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X380MM 2025201 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X400MM 2025202 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X400MM 2025202 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X420MM 2025203 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 13X420MM 2025203 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X170MM 2025204 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X170MM 2025204 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X200MM 2025205 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X200MM 2025205 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X300MM 2025206 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X300MM 2025206 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X320MM 2025207 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X320MM 2025207 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X340MM 2025208 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X340MM 2025208 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X360MM 2025209 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X360MM 2025209 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X380MM 2025210 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X380MM 2025210 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X400MM 2025211 CDM 278 RC facility both 6813 6813 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X400MM 2025211 CDM 278 RC facility both 6813 6813 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X420MM 2025212 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 SUPRACONDYLAR NAIL 14X420MM 2025212 CDM 278 RC facility both 7802 7802 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX25MM 2025214 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX25MM 2025214 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX27.5MM 2025215 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX27.5MM 2025215 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX30MM 2025217 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX30MM 2025217 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX32.5MM 2025219 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX32.5MM 2025219 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX40MM 2025225 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX40MM 2025225 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX42.5MM 2025227 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX42.5MM 2025227 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX45MM 2025229 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX45MM 2025229 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX47.5MM 2025231 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX47.5MM 2025231 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX50MM 2025232 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX50MM 2025232 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX52.5MM 2025233 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX52.5MM 2025233 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX55MM 2025234 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX55MM 2025234 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX57.5MM 2025235 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX57.5MM 2025235 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX60MM 2025236 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX60MM 2025236 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX65MM 2025237 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX65MM 2025237 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX70MM 2025238 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX70MM 2025238 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX75MM 2025239 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX75MM 2025239 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX80MM 2025240 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX80MM 2025240 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX85MM 2025241 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX85MM 2025241 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX90MM 2025242 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX90MM 2025242 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX95MM 2025243 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX95MM 2025243 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX100MM 2025244 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX100MM 2025244 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX105MM 2025245 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX105MM 2025245 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX110MM 2025246 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX110MM 2025246 CDM 278 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX115MM 2025247 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX115MM 2025247 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX120MM 2025248 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX120MM 2025248 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TI SET 8X17.5MM 2025249 CDM 278 RC facility both 497 497 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TI SET 8X17.5MM 2025249 CDM 278 RC facility both 497 497 Gross Charge Type: NIHD_Hosp_Profee_Price TI END CAP STANDARD 0MM 2025250 CDM 278 RC facility both 497 497 Gross Charge Type: NIHD_Hosp_Profee_Price TI END CAP STANDARD 0MM 2025250 CDM 278 RC facility both 497 497 Gross Charge Type: NIHD_Hosp_Profee_Price TI END CAP 5MM +5 2025251 CDM 278 RC facility both 789 789 Gross Charge Type: NIHD_Hosp_Profee_Price TI END CAP 5MM +5 2025251 CDM 278 RC facility both 789 789 Gross Charge Type: NIHD_Hosp_Profee_Price TI END CAP 10MM +10 2025252 CDM 278 RC facility both 497 497 Gross Charge Type: NIHD_Hosp_Profee_Price TI END CAP 10MM +10 2025252 CDM 278 RC facility both 497 497 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X75MM 2025253 CDM 278 RC facility both 2198 2198 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X75MM 2025253 CDM 278 RC facility both 2198 2198 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X80MM 2025254 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X80MM 2025254 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X85MM 2025255 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X85MM 2025255 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X90MM 2025256 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X90MM 2025256 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X95MM 2025257 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X95MM 2025257 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X100MM 2025258 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X100MM 2025258 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X105MM 2025259 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X105MM 2025259 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X110MM 2025260 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X110MM 2025260 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X115MM 2025261 CDM 278 RC facility both 2198 2198 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X115MM 2025261 CDM 278 RC facility both 2198 2198 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X120MM 2025262 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price TI LAG SCREW 10.5X120MM 2025262 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA 3 TI.LAGSCREW 10.5X125MM 2025263 CDM 278 RC facility both 2198 2198 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA 3 TI.LAGSCREW 10.5X125MM 2025263 CDM 278 RC facility both 2198 2198 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA 3 TI.LAGSCREW 10.5X130MM 2025264 CDM 278 RC facility both 2198 2198 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA 3 TI.LAGSCREW 10.5X130MM 2025264 CDM 278 RC facility both 2198 2198 Gross Charge Type: NIHD_Hosp_Profee_Price TI TROCHANTERIC NAIL KIT 11X180MM X 125 2025292 CDM 278 RC facility both 3522 3522 Gross Charge Type: NIHD_Hosp_Profee_Price TI TROCHANTERIC NAIL KIT 11X180MM X 125 2025292 CDM 278 RC facility both 3522 3522 Gross Charge Type: NIHD_Hosp_Profee_Price TI TROCHANTERIC NAIL KIT 11X180MM X 130 2025293 CDM 278 RC facility both 3522 3522 Gross Charge Type: NIHD_Hosp_Profee_Price TI TROCHANTERIC NAIL KIT 11X180MM X 130 2025293 CDM 278 RC facility both 3522 3522 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X14MM 2025294 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X14MM 2025294 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X16MM 2025295 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X16MM 2025295 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X18MM 2025296 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X18MM 2025296 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X20MM 2025297 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X20MM 2025297 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X22MM 2025298 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X22MM 2025298 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X24MM 2025299 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X24MM 2025299 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X26MM 2025301 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X26MM 2025301 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X28MM 2025302 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X28MM 2025302 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X30MM 2025303 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X30MM 2025303 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X32MM 2025304 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X32MM 2025304 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X34MM 2025305 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X34MM 2025305 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X36MM 2025306 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X36MM 2025306 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X38MM 2025307 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X38MM 2025307 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X40MM 2025308 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X40MM 2025308 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X42MM 2025309 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X42MM 2025309 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X44MM 2025310 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X44MM 2025310 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X46MM 2025311 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X46MM 2025311 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X48MM 2025312 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X48MM 2025312 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X50MM 2025313 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X50MM 2025313 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X55MM 2025314 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X55MM 2025314 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X60MM 2025315 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III SS CAN SCR 4X60MM 2025315 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 50MM 2025316 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 50MM 2025316 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 55MM 2025317 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 55MM 2025317 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 60MM 2025318 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 60MM 2025318 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 65MM 2025319 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 65MM 2025319 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 70MM 2025320 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 70MM 2025320 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 75MM 2025321 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 75MM 2025321 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 80MM 2025322 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 80MM 2025322 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 85MM 2025323 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 85MM 2025323 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 90MM 2025324 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 90MM 2025324 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 95MM 2025325 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 95MM 2025325 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 100MM 2025326 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 100MM 2025326 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 105MM 2025327 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 105MM 2025327 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 110MM 2025328 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 110MM 2025328 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 115MM 2025329 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 115MM 2025329 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 120MM 2025330 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 120MM 2025330 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 125MM 2025331 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 125MM 2025331 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 130MM 2025332 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA PLUS LAG SCREW 130MM 2025332 CDM 278 RC facility both 1249 1249 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X10MM 2025333 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X10MM 2025333 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X12MM 2025334 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X12MM 2025334 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X14MM 2025335 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X14MM 2025335 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X16MM 2025336 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X16MM 2025336 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X18MM 2025337 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X18MM 2025337 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X20MM 2025338 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X20MM 2025338 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X22MM 2025339 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X22MM 2025339 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X24MM 2025340 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X24MM 2025340 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X26MM 2025341 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X26MM 2025341 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X28MM 2025342 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X28MM 2025342 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X30MM 2025343 CDM 278 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X30MM 2025343 CDM 278 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X32MM 2025344 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X32MM 2025344 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X34MM 2025345 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X34MM 2025345 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X36MM 2025346 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X36MM 2025346 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X38MM 2025347 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X38MM 2025347 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X40MM 2025348 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X40MM 2025348 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X42MM 2025349 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X42MM 2025349 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X44MM 2025350 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X44MM 2025350 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X46MM 2025351 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X46MM 2025351 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X48MM 2025352 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X48MM 2025352 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X50MM 2025353 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X50MM 2025353 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X55MM 2025354 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X55MM 2025354 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X60MM 2025355 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 3.5X60MM 2025355 CDM 278 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X14MM 2025356 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X14MM 2025356 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X16MM 2025357 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X16MM 2025357 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X18MM 2025358 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X18MM 2025358 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X20MM 2025359 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X20MM 2025359 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X22MM 2025360 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X22MM 2025360 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X24MM 2025361 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X24MM 2025361 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X26MM 2025362 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X26MM 2025362 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X28MM 2025363 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X28MM 2025363 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X30MM 2025365 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X30MM 2025365 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X32MM 2025366 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X32MM 2025366 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X34MM 2025369 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X34MM 2025369 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X36MM 2025371 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X36MM 2025371 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X38MM 2025373 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X38MM 2025373 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X40MM 2025375 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X40MM 2025375 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X42MM 2025377 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X42MM 2025377 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X44MM 2025378 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X44MM 2025378 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X46MM 2025379 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X46MM 2025379 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X48MM 2025380 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X48MM 2025380 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X50MM 2025381 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X50MM 2025381 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X52MM 2025382 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X52MM 2025382 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X54MM 2025384 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X54MM 2025384 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X56MM 2025386 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X56MM 2025386 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X58MM 2025387 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X58MM 2025387 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X60MM 2025388 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X60MM 2025388 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X62MM 2025389 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X62MM 2025389 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X64MM 2025390 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X64MM 2025390 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X66MM 2025391 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X66MM 2025391 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X68MM 2025392 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X68MM 2025392 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X70MM 2025393 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW 4.5X70MM 2025393 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X75MM CANCELLOUS SCREW 32MM T/L 2025414 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X75MM CANCELLOUS SCREW 32MM T/L 2025414 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X80MM CANCELLOUS SCREW 32MM T/L 2025415 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X80MM CANCELLOUS SCREW 32MM T/L 2025415 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X300MMX125 2025419 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X300MMX125 2025419 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X320MMX125 2025420 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X320MMX125 2025420 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X340MMX125 2025421 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X340MMX125 2025421 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X360MMX125 RT 2025422 CDM 278 RC facility both 11267 11267 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X360MMX125 RT 2025422 CDM 278 RC facility both 11267 11267 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X380MMX125 2025423 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X380MMX125 2025423 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X400MMX125 RT 2025424 CDM 278 RC facility both 11267 11267 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X400MMX125 RT 2025424 CDM 278 RC facility both 11267 11267 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X420MMX125 2025425 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X420MMX125 2025425 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X440MMX125 2025426 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X440MMX125 2025426 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X300MMX130 2025427 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X300MMX130 2025427 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X320MMX130 2025428 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X320MMX130 2025428 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X340MMX130 2025429 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X340MMX130 2025429 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X360MMX130 2025430 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X360MMX130 2025430 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X380MMX130 2025431 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X380MMX130 2025431 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X400MMX130 2025432 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X400MMX130 2025432 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X420MMX130 RT 2025433 CDM 278 RC facility both 10120 10120 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X420MMX130 RT 2025433 CDM 278 RC facility both 10120 10120 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X440MMX130 2025434 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI RIGHT 11X440MMX130 2025434 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X20MM CANCELLOUS SCREW F/T 2025435 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X20MM CANCELLOUS SCREW F/T 2025435 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345410 2025448 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345410 2025448 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345412 2025449 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345412 2025449 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345414 2025450 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345414 2025450 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345416 2025451 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345416 2025451 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345418 2025452 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345418 2025452 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345420 2025453 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345420 2025453 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345422 2025454 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345422 2025454 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345424 2025455 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345424 2025455 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345426 2025456 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345426 2025456 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345428 2025457 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345428 2025457 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 2025458 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 2025458 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345432 2025459 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345432 2025459 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345434 2025460 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345434 2025460 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345436 2025461 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345436 2025461 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345438 2025462 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345438 2025462 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345440 2025463 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345440 2025463 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345445 2025464 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345445 2025464 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345450 2025465 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345450 2025465 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345455 2025466 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345455 2025466 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345460 2025467 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345460 2025467 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345510 2025468 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345510 2025468 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345512 2025469 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345512 2025469 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345514 2025470 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345514 2025470 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345516 2025471 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345516 2025471 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345518 2025472 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345518 2025472 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345520 2025473 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345520 2025473 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345522 2025474 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345522 2025474 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345524 2025475 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345524 2025475 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345526 2025476 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345526 2025476 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345528 2025477 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345528 2025477 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345530 2025478 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345530 2025478 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345532 2025479 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345532 2025479 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345534 2025480 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345534 2025480 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345536 2025481 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345536 2025481 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345538 2025482 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345538 2025482 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345540 2025483 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345540 2025483 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345545 2025484 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345545 2025484 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345550 2025485 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345550 2025485 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345555 2025486 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345555 2025486 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345560 2025487 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS SCREW 4.0 SS 345560 2025487 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW SS 349620 2025494 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price SELF TAP CORTICAL SCREW SS 349620 2025494 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X300MMX125 2025500 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X300MMX125 2025500 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X320MMX125 2025501 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X320MMX125 2025501 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X340MMX125 2025502 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X340MMX125 2025502 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X360MMX125 2025503 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X360MMX125 2025503 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X400MMX125 2025505 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X400MMX125 2025505 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X420MMX125 2025506 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X420MMX125 2025506 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X440MMX125 2025507 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X440MMX125 2025507 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X300MMX130 LT 2025508 CDM 278 RC facility both 11267 11267 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X300MMX130 LT 2025508 CDM 278 RC facility both 11267 11267 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X320MMX130 2025509 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X320MMX130 2025509 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X340MMX130 2025510 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X340MMX130 2025510 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X360MMX130 2025511 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X360MMX130 2025511 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X380MMX130 2025512 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X380MMX130 2025512 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X400MMX130 2025513 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X400MMX130 2025513 CDM 278 RC facility both 5824 5824 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X420MMX130 2025514 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X420MMX130 2025514 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X440MMX130 2025515 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price LONG NAIL KIT R1/5 TI LEFT 11X440MMX130 2025515 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price 3.0 LOCKING INSERT 2025516 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price 3.0 LOCKING INSERT 2025516 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0 LOCKING INSERT 2025517 CDM 278 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0 LOCKING INSERT 2025517 CDM 278 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0 LOCKING INSERT 2025518 CDM 272 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0 LOCKING INSERT 2025518 CDM 272 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0 CABLE PLUG 2025520 CDM 278 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0 CABLE PLUG 2025520 CDM 278 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X10MM PERIPROSTH. SCREW 2025521 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X10MM PERIPROSTH. SCREW 2025521 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X12MM PERIPROSTH. SCREW 2025522 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X12MM PERIPROSTH. SCREW 2025522 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X14MM PERIPROSTH. SCREW 2025523 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X14MM PERIPROSTH. SCREW 2025523 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X16MM PERIPROSTH. SCREW 2025524 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X16MM PERIPROSTH. SCREW 2025524 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X18MM PERIPROSTH. SCREW 2025525 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X18MM PERIPROSTH. SCREW 2025525 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X20MM PERIPROSTH. SCREW 2025526 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0X20MM PERIPROSTH. SCREW 2025526 CDM 278 RC facility both 699 699 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L8MM 2025527 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L8MM 2025527 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L10MM 2025528 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L10MM 2025528 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L12MM 2025529 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L12MM 2025529 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L14MM 2025530 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L14MM 2025530 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L16MM 2025531 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L16MM 2025531 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L18MM 2025532 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L18MM 2025532 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L20MM 2025533 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L20MM 2025533 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L22MM 2025534 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L22MM 2025534 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L24MM 2025535 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L24MM 2025535 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L26MM 2025536 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L26MM 2025536 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L28MM 2025537 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L28MM 2025537 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L30MM 2025538 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 3.0MM / L30MM 2025538 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L14MM 2025562 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L14MM 2025562 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L16MM 2025563 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L16MM 2025563 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L18MM 2025564 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L18MM 2025564 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L20MM 2025565 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L20MM 2025565 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L22MM 2025566 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L22MM 2025566 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L24MM 2025567 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L24MM 2025567 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L26MM 2025568 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L26MM 2025568 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L28MM 2025569 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L28MM 2025569 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L30MM 2025570 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L30MM 2025570 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L32MM 2025571 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L32MM 2025571 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L34MM 2025572 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L34MM 2025572 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L36MM 2025573 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L36MM 2025573 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L38MM 2025574 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L38MM 2025574 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L40MM 2025575 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L40MM 2025575 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L42MM 2025576 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L42MM 2025576 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L44MM 2025577 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L44MM 2025577 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L46MM 2025578 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L46MM 2025578 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L48MM 2025579 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L48MM 2025579 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L50MM 2025580 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L50MM 2025580 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L55MM 2025581 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L55MM 2025581 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L60MM 2025582 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW AXSOS 4.0MM / L60MM 2025582 CDM 278 RC facility both 554 554 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III WASHER FOR 6.5/8.0MM SCREWS SS 2025584 CDM 278 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III WASHER FOR 6.5/8.0MM SCREWS SS 2025584 CDM 278 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULATED SCREW WASHER SS 2025586 CDM 278 RC facility both 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULATED SCREW WASHER SS 2025586 CDM 278 RC facility both 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.0 STRYKER 2025587 CDM 272 RC facility both 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.0 STRYKER 2025587 CDM 272 RC facility both 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.6X150MM SS 2025589 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.6X150MM SS 2025589 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 2.0MM STRYKER 2025590 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 2.0MM STRYKER 2025590 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price CALCANEUS STANDARD PLATE SMALL 2025594 CDM 278 RC facility both 3105 3105 Gross Charge Type: NIHD_Hosp_Profee_Price CALCANEUS STANDARD PLATE SMALL 2025594 CDM 278 RC facility both 3105 3105 Gross Charge Type: NIHD_Hosp_Profee_Price CALCANEUS STANDARD PLATE MEDIUM 2025595 CDM 278 RC facility both 3105 3105 Gross Charge Type: NIHD_Hosp_Profee_Price CALCANEUS STANDARD PLATE MEDIUM 2025595 CDM 278 RC facility both 3105 3105 Gross Charge Type: NIHD_Hosp_Profee_Price CALCANEUS STANDARD PLATE LARGE 2025596 CDM 278 RC facility both 3105 3105 Gross Charge Type: NIHD_Hosp_Profee_Price CALCANEUS STANDARD PLATE LARGE 2025596 CDM 278 RC facility both 3105 3105 Gross Charge Type: NIHD_Hosp_Profee_Price CURVED PLATE 4 HOLES 2025597 CDM 278 RC facility both 2025 2025 Gross Charge Type: NIHD_Hosp_Profee_Price CURVED PLATE 4 HOLES 2025597 CDM 278 RC facility both 2025 2025 Gross Charge Type: NIHD_Hosp_Profee_Price BROAD STRAIGHT PLATE LONG 2025609 CDM 278 RC facility both 2564 2564 Gross Charge Type: NIHD_Hosp_Profee_Price BROAD STRAIGHT PLATE LONG 2025609 CDM 278 RC facility both 2564 2564 Gross Charge Type: NIHD_Hosp_Profee_Price T-PLATE 2025614 CDM 278 RC facility both 1668 1668 Gross Charge Type: NIHD_Hosp_Profee_Price T-PLATE 2025614 CDM 278 RC facility both 1668 1668 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX STRAIGHT PLATE 2 HOLE 2025617 CDM 278 RC facility both 1123 1123 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX STRAIGHT PLATE 2 HOLE 2025617 CDM 278 RC facility both 1123 1123 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX STRAIGHT PLATE 3 HOLE 2025618 CDM 278 RC facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX STRAIGHT PLATE 3 HOLE 2025618 CDM 278 RC facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price STRAIGHT PLATE VARIAX FIBULA 4HOLE L60MM 2025619 CDM 278 RC facility both 1600 1600 Gross Charge Type: NIHD_Hosp_Profee_Price STRAIGHT PLATE VARIAX FIBULA 4HOLE L60MM 2025619 CDM 278 RC facility both 1600 1600 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAX STRAIGHT PLATE, 5 HOLE" 2025620 CDM 278 RC facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAX STRAIGHT PLATE, 5 HOLE" 2025620 CDM 278 RC facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAX STRAIGHT PLATE, 6 HOLE" 2025621 CDM 278 RC facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAX STRAIGHT PLATE, 6 HOLE" 2025621 CDM 278 RC facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAX STRAIGHT PLATE, 7 HOLE" 2025622 CDM 278 RC facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAX STRAIGHT PLATE, 7 HOLE" 2025622 CDM 278 RC facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 3 HOLE 2025623 CDM 278 RC facility both 1646 1646 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 3 HOLE 2025623 CDM 278 RC facility both 1646 1646 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 4 HOLE 2025624 CDM 278 RC facility both 1646 1646 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 4 HOLE 2025624 CDM 278 RC facility both 1646 1646 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 5 HOLE 2025625 CDM 278 RC facility both 1646 1646 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 5 HOLE 2025625 CDM 278 RC facility both 1646 1646 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 6 HOLE 2025626 CDM 278 RC facility both 2542 2542 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 6 HOLE 2025626 CDM 278 RC facility both 2542 2542 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 7 HOLE 2025627 CDM 278 RC facility both 2760 2760 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 7 HOLE 2025627 CDM 278 RC facility both 2760 2760 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 8 HOLE 2025628 CDM 278 RC facility both 2760 2760 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 8 HOLE 2025628 CDM 278 RC facility both 2760 2760 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 9 HOLE 2025629 CDM 278 RC facility both 2760 2760 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL FIBULA PLATE 9 HOLE 2025629 CDM 278 RC facility both 2760 2760 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X8MM 2025630 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X8MM 2025630 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X10MM 2025631 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X10MM 2025631 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X12MM 40-27012 2025632 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X12MM 40-27012 2025632 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X14MM 40-27014 2025633 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X14MM 40-27014 2025633 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X16MM 40-27016 2025634 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X16MM 40-27016 2025634 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE NONLOCKING SCREW T7 2.7X18MM 2025635 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE NONLOCKING SCREW T7 2.7X18MM 2025635 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X20MM 40-27020 2025636 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X20MM 40-27020 2025636 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X22MM 40-27022 2025637 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X22MM 40-27022 2025637 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X24MM 40-27024 2025638 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X24MM 40-27024 2025638 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X26MM 40-27026 2025639 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X26MM 40-27026 2025639 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X28MM 2025640 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X28MM 2025640 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X30MM 2025641 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X30MM 2025641 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X32MM 2025642 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X32MM 2025642 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X34MM 2025643 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X34MM 2025643 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X36MM 2025644 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X36MM 2025644 CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X38MM 2025645 CDM 272 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X38MM 2025645 CDM 272 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X40MM 2025646 CDM 272 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X40MM 2025646 CDM 272 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X45MM 2025647 CDM 272 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X45MM 2025647 CDM 272 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X50MM 2025648 CDM 272 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X50MM 2025648 CDM 272 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X8MM 2025649 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X8MM 2025649 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X10MM 2025650 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X10MM 2025650 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X12MM 2025651 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X12MM 2025651 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X14MM 2025652 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X14MM 2025652 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X16MM 2025653 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X16MM 2025653 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X18MM 2025654 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X18MM 2025654 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X20MM 2025655 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X20MM 2025655 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X22MM 2025656 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X22MM 2025656 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X24MM 2025657 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X24MM 2025657 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X26MM 2025658 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X26MM 2025658 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X28MM 2025659 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X28MM 2025659 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X30MM 2025660 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X30MM 2025660 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X32MM 2025661 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X32MM 2025661 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X34MM 2025662 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X34MM 2025662 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X36MM 2025663 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X36MM 2025663 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X38MM 2025664 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X38MM 2025664 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X40MM 2025665 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X40MM 2025665 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X45MM 2025666 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X45MM 2025666 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X50MM 2025667 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T7 2.7X50MM 2025667 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X10MM 2025668 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X10MM 2025668 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X12MM 2025669 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X12MM 2025669 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE T10 3.5X14MM 2025670 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE T10 3.5X14MM 2025670 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X16MM 2025671 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X16MM 2025671 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X18MM 2025672 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X18MM 2025672 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X20MM 2025673 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X20MM 2025673 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X22MM 2025674 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X22MM 2025674 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X24MM 2025675 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X24MM 2025675 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X26MM 2025676 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X26MM 2025676 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X28MM 2025677 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X28MM 2025677 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X30MM 2025678 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X30MM 2025678 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X32MM 2025679 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X32MM 2025679 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X34MM 2025680 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X34MM 2025680 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X36MM 2025681 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X36MM 2025681 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X38MM 2025682 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X38MM 2025682 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X40MM 2025683 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X40MM 2025683 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X42MM 2025684 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X42MM 2025684 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X44MM 2025685 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X44MM 2025685 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X46MM 2025686 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X46MM 2025686 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X48MM 2025687 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X48MM 2025687 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X50MM 2025688 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X50MM 2025688 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X55MM 2025689 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X55MM 2025689 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X60MM 2025690 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X60MM 2025690 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X65MM 2025691 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X65MM 2025691 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X70MM 2025692 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 3.5X70MM 2025692 CDM 278 RC facility both 327 327 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X10MM 2025693 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X10MM 2025693 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW FOOT LOCKING T10 3.5X12MM 2025694 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW FOOT LOCKING T10 3.5X12MM 2025694 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING FOOT T10 3.5X14MM 2025695 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING FOOT T10 3.5X14MM 2025695 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X16MM 2025696 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X16MM 2025696 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW FOOT LOCKING T10 3.5X18MM 2025697 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW FOOT LOCKING T10 3.5X18MM 2025697 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING FOOT T10 3.5X20MM 2025698 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING FOOT T10 3.5X20MM 2025698 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X22MM 2025699 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X22MM 2025699 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X24MM 2025700 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X24MM 2025700 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X26MM 2025701 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X26MM 2025701 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X28MM 2025702 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X28MM 2025702 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X30MM 2025703 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X30MM 2025703 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X32MM 2025704 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X32MM 2025704 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X34MM 2025705 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X34MM 2025705 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X38MM 2025706 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X38MM 2025706 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X40MM 2025707 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X40MM 2025707 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X42MM 2025708 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X42MM 2025708 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X44MM 2025709 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X44MM 2025709 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X46MM 2025710 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X46MM 2025710 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X48MM 2025711 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X48MM 2025711 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X50MM 2025712 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X50MM 2025712 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X55MM 2025713 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X55MM 2025713 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X60MM 2025714 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X60MM 2025714 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X65MM 2025715 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X65MM 2025715 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X70MM 2025716 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X70MM 2025716 CDM 278 RC facility both 647 647 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 4 HOLE / L58MM 2025717 CDM 278 RC facility both 467 467 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 4 HOLE / L58MM 2025717 CDM 278 RC facility both 467 467 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 6 HOLE / L84MM 2025718 CDM 278 RC facility both 597 597 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 6 HOLE / L84MM 2025718 CDM 278 RC facility both 597 597 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 7 HOLE / L97MM 2025719 CDM 278 RC facility both 597 597 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 7 HOLE / L97MM 2025719 CDM 278 RC facility both 597 597 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 8 HOLE / L110MM 2025720 CDM 278 RC facility both 665 665 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 8 HOLE / L110MM 2025720 CDM 278 RC facility both 665 665 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 10 HOLE / L136MM 2025721 CDM 278 RC facility both 665 665 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING COMPR PLATE 10 HOLE / L136MM 2025721 CDM 278 RC facility both 665 665 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING RECON PLATE 4 HOLE / L48MM 2025722 CDM 278 RC facility both 1686 1686 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING RECON PLATE 4 HOLE / L48MM 2025722 CDM 278 RC facility both 1686 1686 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING RECON PLATE 6 HOLE / L72MM 2025723 CDM 278 RC facility both 1901 1901 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING RECON PLATE 6 HOLE / L72MM 2025723 CDM 278 RC facility both 1901 1901 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING RECON PLATE 8 HOLE / L96MM 2025724 CDM 278 RC facility both 2110 2110 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING RECON PLATE 8 HOLE / L96MM 2025724 CDM 278 RC facility both 2110 2110 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING RECON PLATE 10 HOLE / L120MM 2025725 CDM 278 RC facility both 2323 2323 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING RECON PLATE 10 HOLE / L120MM 2025725 CDM 278 RC facility both 2323 2323 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING 1/3 TUB PLATE 4 HOLE / L50MM 2025726 CDM 278 RC facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING 1/3 TUB PLATE 4 HOLE / L50MM 2025726 CDM 278 RC facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING 1/3 TUB PLATE 6 HOLE / L76MM 2025727 CDM 278 RC facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING 1/3 TUB PLATE 6 HOLE / L76MM 2025727 CDM 278 RC facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING 1/3 TUB PLATE 8 HOLE / L102MM 2025728 CDM 278 RC facility both 607 607 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING 1/3 TUB PLATE 8 HOLE / L102MM 2025728 CDM 278 RC facility both 607 607 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING 1/3 TUB PLATE 10 HOLE / L128MM 2025729 CDM 278 RC facility both 607 607 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING 1/3 TUB PLATE 10 HOLE / L128MM 2025729 CDM 278 RC facility both 607 607 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 4 HOLE 2025745 CDM 278 RC facility both 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 4 HOLE 2025745 CDM 278 RC facility both 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 6 HOLE 2025746 CDM 278 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 6 HOLE 2025746 CDM 278 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 7 HOLE 2025747 CDM 278 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 7 HOLE 2025747 CDM 278 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 8 HOLE SS 2025748 CDM 278 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 8 HOLE SS 2025748 CDM 278 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 10 HOLE SS 2025749 CDM 278 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price COMPRESSION PLATE 10 HOLE SS 2025749 CDM 278 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 2 HOLE SS 2025750 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 2 HOLE SS 2025750 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 4 HOLE SS 2025751 CDM 278 RC facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 4 HOLE SS 2025751 CDM 278 RC facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 5 HOLE SS 2025752 CDM 278 RC facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 5 HOLE SS 2025752 CDM 278 RC facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 6 HOLE SS 2025753 CDM 278 RC facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 6 HOLE SS 2025753 CDM 278 RC facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 7 HOLE SS 2025754 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 7 HOLE SS 2025754 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 10 HOLE SS 2025756 CDM 278 RC facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price ONE THIRD TUB. PLATE 10 HOLE SS 2025756 CDM 278 RC facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price T-PLATE 4/4 HOLE SS 2025761 CDM 278 RC facility both 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price T-PLATE 4/4 HOLE SS 2025761 CDM 278 RC facility both 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price T-PLATE 4 HOLE L79MM 2025770 CDM 278 RC facility both 809 809 Gross Charge Type: NIHD_Hosp_Profee_Price T-PLATE 4 HOLE L79MM 2025770 CDM 278 RC facility both 809 809 Gross Charge Type: NIHD_Hosp_Profee_Price PROXIMAL LAT HUMERUS PLATE TS 3 HOLE / L 2025775 CDM 278 RC facility both 5333 5333 Gross Charge Type: NIHD_Hosp_Profee_Price PROXIMAL LAT HUMERUS PLATE TS 3 HOLE / L 2025775 CDM 278 RC facility both 5333 5333 Gross Charge Type: NIHD_Hosp_Profee_Price PROXIMAL LAT HUMERUS PLATE TS 3 HOLE / R 2025776 CDM 278 RC facility both 5333 5333 Gross Charge Type: NIHD_Hosp_Profee_Price PROXIMAL LAT HUMERUS PLATE TS 3 HOLE / R 2025776 CDM 278 RC facility both 5333 5333 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 2.0MM X 102MM WL50MM AO-SHAFT 2025777 CDM 272 RC facility both 437 437 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 2.0MM X 102MM WL50MM AO-SHAFT 2025777 CDM 272 RC facility both 437 437 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 2.6MM X 122MM WL70MM AO-SHAFT 2025778 CDM 272 RC facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 2.6MM X 122MM WL70MM AO-SHAFT 2025778 CDM 272 RC facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 03.6MM X 122MM AO FITTING 2025779 CDM 278 RC facility both 485 485 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 03.6MM X 122MM AO FITTING 2025779 CDM 278 RC facility both 485 485 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE FULLY THREADED 1.6MM X 200MM 2025780 CDM 278 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE FULLY THREADED 1.6MM X 200MM 2025780 CDM 278 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SMOOTH 1.4MM X 100MM 2025781 CDM 278 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SMOOTH 1.4MM X 100MM 2025781 CDM 278 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price HII MRI 10 HOLE PIN CLAMP 2025784 CDM 278 RC facility both 1789 1789 Gross Charge Type: NIHD_Hosp_Profee_Price HII MRI 10 HOLE PIN CLAMP 2025784 CDM 278 RC facility both 1789 1789 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 RODTOROD COUPLING DIA 058/11MM 2025785 CDM 272 RC facility both 2200 2200 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 RODTOROD COUPLING DIA 058/11MM 2025785 CDM 272 RC facility both 2200 2200 Gross Charge Type: NIHD_Hosp_Profee_Price PINTOROD COUPLING DIA4/5/6MM DIA5/8/11MM 2025787 CDM 272 RC facility both 2014 2014 Gross Charge Type: NIHD_Hosp_Profee_Price PINTOROD COUPLING DIA4/5/6MM DIA5/8/11MM 2025787 CDM 272 RC facility both 2014 2014 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 5 HOLE PIN CLAMP DIA 4/5/6MM 2025789 CDM 278 RC facility both 2562 2562 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 5 HOLE PIN CLAMP DIA 4/5/6MM 2025789 CDM 278 RC facility both 2562 2562 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 POST STRAIGHT DIA 11MM 2025790 CDM 272 RC facility both 484 484 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 POST STRAIGHT DIA 11MM 2025790 CDM 272 RC facility both 484 484 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 POST 30DEG ANGLED DIA 11MM 2025791 CDM 272 RC facility both 399 399 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 POST 30DEG ANGLED DIA 11MM 2025791 CDM 272 RC facility both 399 399 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 POST 90DEG ANGLED DIA 11MM 2025792 CDM 272 RC facility both 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 POST 90DEG ANGLED DIA 11MM 2025792 CDM 272 RC facility both 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price 5HOLE PIN CLAMP 2 POSTS 30DEG DIA4/5/6MM 2025793 CDM 278 RC facility both 2472 2472 Gross Charge Type: NIHD_Hosp_Profee_Price 5HOLE PIN CLAMP 2 POSTS 30DEG DIA4/5/6MM 2025793 CDM 278 RC facility both 2472 2472 Gross Charge Type: NIHD_Hosp_Profee_Price SEMI-CIRCULAR CURVED ROD 011X220MM 2025794 CDM 272 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price SEMI-CIRCULAR CURVED ROD 011X220MM 2025794 CDM 272 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X150MM 2025795 CDM 272 RC facility both 1091 1091 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X150MM 2025795 CDM 272 RC facility both 1091 1091 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X250MM 2025796 CDM 272 RC facility both 1267 1267 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X250MM 2025796 CDM 272 RC facility both 1267 1267 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X350MM 2025797 CDM 272 RC facility both 1149 1149 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X350MM 2025797 CDM 272 RC facility both 1149 1149 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X400MM 2025798 CDM 278 RC facility both 1487 1487 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X400MM 2025798 CDM 278 RC facility both 1487 1487 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X450MM 2025799 CDM 272 RC facility both 1315 1315 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X450MM 2025799 CDM 272 RC facility both 1315 1315 Gross Charge Type: NIHD_Hosp_Profee_Price 5X150 APEX S/D HALF PIN 40 THR 2025811 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price 5X150 APEX S/D HALF PIN 40 THR 2025811 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price 5X150 APEX S/D HALF PIN 50 THR 2025812 CDM 278 RC facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price 5X150 APEX S/D HALF PIN 50 THR 2025812 CDM 278 RC facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price 5X180 APEX S/D HALF PIN 50 THR 5018-6-180 2025813 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price 5X180 APEX S/D HALF PIN 50 THR 5018-6-180 2025813 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price 5X200 APEX S/D HALF PIN 60 THR 2025814 CDM 278 RC facility both 291 291 Gross Charge Type: NIHD_Hosp_Profee_Price 5X200 APEX S/D HALF PIN 60 THR 2025814 CDM 278 RC facility both 291 291 Gross Charge Type: NIHD_Hosp_Profee_Price 5X250 APEX S/D HALF PIN 70 THR 2025815 CDM 278 RC facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price 5X250 APEX S/D HALF PIN 70 THR 2025815 CDM 278 RC facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price 4X120 APEX S/D HALF PIN 30 THR 2025816 CDM 278 RC facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price 4X120 APEX S/D HALF PIN 30 THR 2025816 CDM 278 RC facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price SELF-DRILLING1/2PIN APEX DIA3/5MMX20X120 2025819 CDM 278 RC facility both 617 617 Gross Charge Type: NIHD_Hosp_Profee_Price SELF-DRILLING1/2PIN APEX DIA3/5MMX20X120 2025819 CDM 278 RC facility both 617 617 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM PROTECTIVE TIP CAPS WHITE 2025820 CDM 272 RC facility both 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM PROTECTIVE TIP CAPS WHITE 2025820 CDM 272 RC facility both 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM PROTECTIVE TIP CAPS BLUE 2025821 CDM 272 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM PROTECTIVE TIP CAPS BLUE 2025821 CDM 272 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price APEX TRANSFIX 4X250 PIN 5X50THR 2025822 CDM 278 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price APEX TRANSFIX 4X250 PIN 5X50THR 2025822 CDM 278 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price 3MM PROTECTIVE TIP CAPS WHITE 2025827 CDM 272 RC facility both 177 177 Gross Charge Type: NIHD_Hosp_Profee_Price 3MM PROTECTIVE TIP CAPS WHITE 2025827 CDM 272 RC facility both 177 177 Gross Charge Type: NIHD_Hosp_Profee_Price TRANSFIXING PIN APEX 05/6MM 40MMX300MM 2025834 CDM 278 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price TRANSFIXING PIN APEX 05/6MM 40MMX300MM 2025834 CDM 278 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price GRAY PT DRILL 3.2MMX200MM 2025836 CDM 272 RC facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price GRAY PT DRILL 3.2MMX200MM 2025836 CDM 272 RC facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 4.0MM FOR 0.5 PINS 2025837 CDM 272 RC facility both 234 234 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 4.0MM FOR 0.5 PINS 2025837 CDM 272 RC facility both 234 234 Gross Charge Type: NIHD_Hosp_Profee_Price GRAY PT DRILL 4.5MMX200MM 2025838 CDM 278 RC facility both 249 249 Gross Charge Type: NIHD_Hosp_Profee_Price GRAY PT DRILL 4.5MMX200MM 2025838 CDM 278 RC facility both 249 249 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X5MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025846 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X5MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025846 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X6MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025847 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X6MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025847 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X7MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025848 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X7MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025848 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X8MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025849 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X8MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025849 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X9MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025850 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X9MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025850 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X10MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025851 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X10MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025851 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X11MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025852 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X11MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025852 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X12MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025853 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X12MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025853 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X13MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025854 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X13MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025854 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X14MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025855 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X14MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025855 CDM 278 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X15MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025856 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X15MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025856 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X16MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025857 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X16MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025857 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X18MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025858 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X18MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025858 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X20MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025859 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X20MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025859 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X22MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025860 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X22MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025860 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X24MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025861 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7X24MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025861 CDM 278 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X16MM 2025862 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X16MM 2025862 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X18MM 2025863 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X18MM 2025863 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X20MM 2025864 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X20MM 2025864 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X22MM 2025865 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X22MM 2025865 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X24MM 2025866 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X24MM 2025866 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X26MM 2025867 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING PEGS T7 2.0X26MM 2025867 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X6MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025868 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X6MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025868 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X8MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025869 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X8MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025869 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X9MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025870 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X9MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025870 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X10MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025871 CDM 278 RC facility both 230 230 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X10MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025871 CDM 278 RC facility both 230 230 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X13MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025874 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X13MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025874 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X14MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025875 CDM 278 RC facility both 230 230 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X14MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025875 CDM 278 RC facility both 230 230 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X15MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025876 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X15MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025876 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X16MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025877 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X16MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025877 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X18MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025878 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X18MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025878 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X20MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025879 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X20MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025879 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X22MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025880 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X22MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025880 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X24MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025881 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X24MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025881 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X26MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025882 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X26MM LOCKING SCREWS,CROSS-PIN,SELF-T" 2025882 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X10MM 2025883 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X10MM 2025883 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X12MM 2025884 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X12MM 2025884 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X14MM 2025885 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X14MM 2025885 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X16MM 2025886 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X16MM 2025886 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X18MM 2025887 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X18MM 2025887 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X20MM 2025888 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X20MM 2025888 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X22MM 2025889 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X22MM 2025889 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X24MM 2025890 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X24MM 2025890 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X26MM 2025891 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X26MM 2025891 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X28MM 2025892 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X28MM 2025892 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X18MM 2025902 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X18MM 2025902 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X20MM 2025903 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X20MM 2025903 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X22MM 2025904 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X22MM 2025904 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X24MM 2025905 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X24MM 2025905 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X26MM 2025906 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X26MM 2025906 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X28MM 2025907 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X28MM 2025907 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X30MM 2025908 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X30MM 2025908 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X32MM 2025909 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X32MM 2025909 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X34MM 2025910 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X34MM 2025910 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X36MM 2025911 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X36MM 2025911 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X38MM 2025912 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X38MM 2025912 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X12MM 53-27212E 2025920 CDM 278 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X12MM 53-27212E 2025920 CDM 278 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X14MM 53-27214E 2025921 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X14MM 53-27214E 2025921 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X16MM 53-27216E 2025922 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X16MM 53-27216E 2025922 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X18MM 2025923 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X18MM 2025923 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X20MM 53-27220E 2025924 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X20MM 53-27220E 2025924 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X22MM 53-27222E 2025925 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X22MM 53-27222E 2025925 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X24MM 53-27224E 2025926 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X24MM 53-27224E 2025926 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X26MM 53-27226E 2025927 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.7X26MM 53-27226E 2025927 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X10MM 2025928 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X10MM 2025928 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X12MM 2025929 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X12MM 2025929 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price "2.7MM TITANIUM BONESCREW,CROSSPIN,SELF14" 2025930 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price "2.7MM TITANIUM BONESCREW,CROSSPIN,SELF14" 2025930 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price "2.7MM TITANIUM LOCKING SCREW,CROSS-PIN,S 53-27616E" 2025931 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price "2.7MM TITANIUM LOCKING SCREW,CROSS-PIN,S 53-27616E" 2025931 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price "2.7MM TITANIUM LOCKING SCREW,CROSS-PIN,S 53-27618E" 2025932 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price "2.7MM TITANIUM LOCKING SCREW,CROSS-PIN,S 53-27618E" 2025932 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X20MM 2025933 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X20MM 2025933 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X22MM 2025934 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X22MM 2025934 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X24MM 2025935 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X24MM 2025935 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE NARROW LEFT 2025949 CDM 278 RC facility both 2339 2339 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE NARROW LEFT 2025949 CDM 278 RC facility both 2339 2339 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE NARROW LFT LONG 2025950 CDM 278 RC facility both 3945 3945 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE NARROW LFT LONG 2025950 CDM 278 RC facility both 3945 3945 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE STANDARD LEFT 2025951 CDM 278 RC facility both 2339 2339 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE STANDARD LEFT 2025951 CDM 278 RC facility both 2339 2339 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE STANDARD L LONG 2025952 CDM 278 RC facility both 3945 3945 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE STANDARD L LONG 2025952 CDM 278 RC facility both 3945 3945 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE NARROW RIGHT 2025953 CDM 278 RC facility both 2339 2339 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE NARROW RIGHT 2025953 CDM 278 RC facility both 2339 2339 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE NARROW R LONG 2025956 CDM 278 RC facility both 3945 3945 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE NARROW R LONG 2025956 CDM 278 RC facility both 3945 3945 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE STANDARD RIGHT 2025957 CDM 278 RC facility both 2339 2339 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE STANDARD RIGHT 2025957 CDM 278 RC facility both 2339 2339 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE STANDARD R LONG 2025958 CDM 278 RC facility both 3945 3945 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR SMARTLOCK DR PLATE STANDARD R LONG 2025958 CDM 278 RC facility both 3945 3945 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE NARROW L 8HOLES XTRASHORT 2025965 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE NARROW L 8HOLES XTRASHORT 2025965 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE NARROW R 8HOLES XTRASHORT 2025966 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE NARROW R 8HOLES XTRASHORT 2025966 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE INTERMEDIATE LEFT 14HOLES 2025967 CDM 278 RC facility both 4204 4204 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE INTERMEDIATE LEFT 14HOLES 2025967 CDM 278 RC facility both 4204 4204 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE INTERMEDIATE RIGHT14HOLES 2025968 CDM 278 RC facility both 4204 4204 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE INTERMEDIATE RIGHT14HOLES 2025968 CDM 278 RC facility both 4204 4204 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE STANDARD LEFT 10HOLES XTR 2025969 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE STANDARD LEFT 10HOLES XTR 2025969 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE STANDARD RIGHT10HOLES XTR 2025970 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DR PLATE STANDARD RIGHT10HOLES XTR 2025970 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE W/ 17MM STOP 2025971 CDM 278 RC facility both 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE W/ 17MM STOP 2025971 CDM 278 RC facility both 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D PLATE,2X2H" 2025982 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D PLATE,2X2H" 2025982 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D PLATE,3X2H" 2025983 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D PLATE,3X2H" 2025983 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D PLATE,4X2H" 2025984 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D PLATE,4X2H" 2025984 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D REPL PL,4X2H" 2025985 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D REPL PL,4X2H" 2025985 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D PLATE,2X2+2H" 2025986 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price "1.7 S PROFYLE HAND LOCK 3-D PLATE,2X2+2H" 2025986 CDM 278 RC facility both 2021 2021 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X5MM BONE SCREWSCROSSPINSELFTAPPING 2026007 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X5MM BONE SCREWSCROSSPINSELFTAPPING 2026007 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X6MM BONE SCREWSCROSSPINSELFTAPPING 2026008 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X6MM BONE SCREWSCROSSPINSELFTAPPING 2026008 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X7MM BONE SCREWSCROSSPINSELFTAPPING 2026009 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X7MM BONE SCREWSCROSSPINSELFTAPPING 2026009 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X8MM BONE SCREWSCROSSPINSELFTAPPING 2026010 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X8MM BONE SCREWSCROSSPINSELFTAPPING 2026010 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X9MM BONE SCREWSCROSSPINSELFTAPPING 2026011 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X9MM BONE SCREWSCROSSPINSELFTAPPING 2026011 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X10MM BONE SCREWSCROSSPINSELFTAPPING 2026012 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X10MM BONE SCREWSCROSSPINSELFTAPPING 2026012 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X11MM BONE SCREWSCROSSPINSELFTAPPING 2026013 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X11MM BONE SCREWSCROSSPINSELFTAPPING 2026013 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X12MM BONE SCREWSCROSSPINSELFTAPPING 2026014 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X12MM BONE SCREWSCROSSPINSELFTAPPING 2026014 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X13MM BONE SCREWSCROSSPINSELFTAPPING 2026015 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X13MM BONE SCREWSCROSSPINSELFTAPPING 2026015 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X14MM BONE SCREWSCROSSPINSELFTAPPING 2026016 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X14MM BONE SCREWSCROSSPINSELFTAPPING 2026016 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X15MM BONE SCREWSCROSSPINSELFTAPPING 2026017 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X15MM BONE SCREWSCROSSPINSELFTAPPING 2026017 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X16MM BONE SCREWSCROSSPINSELFTAPPING 2026018 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X16MM BONE SCREWSCROSSPINSELFTAPPING 2026018 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X18MM BONE SCREWSCROSSPINSELFTAPPING 2026019 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X18MM BONE SCREWSCROSSPINSELFTAPPING 2026019 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X20MM BONE SCREWSCROSSPINSELFTAPPING 2026020 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X20MM BONE SCREWSCROSSPINSELFTAPPING 2026020 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X22MM BONE SCREWSCROSSPINSELFTAPPING 2026021 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X22MM BONE SCREWSCROSSPINSELFTAPPING 2026021 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X24MM BONE SCREWSCROSSPINSELFTAPPING 2026022 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 1.7X24MM BONE SCREWSCROSSPINSELFTAPPING 2026022 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X6MM BONE SCREWSCROSSPINSELFTAPPING 2026027 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X6MM BONE SCREWSCROSSPINSELFTAPPING 2026027 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X8MM BONE SCREWSCROSSPINSELFTAPPING 2026028 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X8MM BONE SCREWSCROSSPINSELFTAPPING 2026028 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X9MM BONE SCREWSCROSSPINSELFTAPPING 2026029 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X9MM BONE SCREWSCROSSPINSELFTAPPING 2026029 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X10MM BONE SCREWSCROSSPINSELFTAPPING 2026030 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X10MM BONE SCREWSCROSSPINSELFTAPPING 2026030 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X12MM BONE SCREWSCROSSPINSELFTAPPING 2026032 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X12MM BONE SCREWSCROSSPINSELFTAPPING 2026032 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X13MM BONE SCREWSCROSSPINSELFTAPPING 2026033 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X13MM BONE SCREWSCROSSPINSELFTAPPING 2026033 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X14MM BONE SCREWSCROSSPINSELFTAPPING 2026034 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X14MM BONE SCREWSCROSSPINSELFTAPPING 2026034 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X16MM BONE SCREWSCROSSPINSELFTAPPING 2026036 CDM 278 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X16MM BONE SCREWSCROSSPINSELFTAPPING 2026036 CDM 278 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X18MM BONE SCREWSCROSSPINSELFTAPPING 2026037 CDM 278 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X18MM BONE SCREWSCROSSPINSELFTAPPING 2026037 CDM 278 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X20MM BONE SCREWSCROSSPINSELFTAPPING 2026038 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X20MM BONE SCREWSCROSSPINSELFTAPPING 2026038 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X22MM BONE SCREWSCROSSPINSELFTAPPING 2026039 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X22MM BONE SCREWSCROSSPINSELFTAPPING 2026039 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X24MM BONE SCREWSCROSSPINSELFTAPPING 2026040 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X24MM BONE SCREWSCROSSPINSELFTAPPING 2026040 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X26MM BONE SCREWSCROSSPINSELFTAPPING 2026041 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X26MM BONE SCREWSCROSSPINSELFTAPPING 2026041 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price 2.5X6MM EMERG SCREWSCROSSPINSELFT 2026042 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 2.5X6MM EMERG SCREWSCROSSPINSELFT 2026042 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 2.5X8MM EMERG SCREWSCROSSPINSELFT 2026043 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 2.5X8MM EMERG SCREWSCROSSPINSELFT 2026043 CDM 278 RC facility both 341 341 Gross Charge Type: NIHD_Hosp_Profee_Price 2.5X10MM EMERG SCREWSCROSSPINSELFT 2026044 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.5X10MM EMERG SCREWSCROSSPINSELFT 2026044 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.5X12MM EMERG SCREWSCROSSPINSELFT 2026045 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 2.5X12MM EMERG SCREWSCROSSPINSELFT 2026045 CDM 278 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 130DEG,3HOLE" 2026050 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 130DEG,3HOLE" 2026050 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 130DEG,4HOLE" 2026051 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 130DEG,4HOLE" 2026051 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 135DEG,2HOLE" 2026052 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 135DEG,2HOLE" 2026052 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 135DEG,3HOLE" 2026053 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 135DEG,3HOLE" 2026053 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 135DEG,4HOLE" 2026054 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 135DEG,4HOLE" 2026054 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 140DEG,2HOLE" 2026055 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 140DEG,2HOLE" 2026055 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 140DEG,3HOLE" 2026056 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 140DEG,3HOLE" 2026056 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 140DEG,4HOLE" 2026057 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price "STND BARREL HIP PLATE,KEYED 140DEG,4HOLE" 2026057 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.4MM DIA AO 2026063 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.4MM DIA AO 2026063 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.9MM DIA AO 2026064 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.9MM DIA AO 2026064 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 100X40MM STRYKER SHAFT 2026065 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 100X40MM STRYKER SHAFT 2026065 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 2.5MM DIA. AO 2026066 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 2.5MM DIA. AO 2026066 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III TI CANN SCR 5X50MM 2026084 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III TI CANN SCR 5X50MM 2026084 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III TI CANN SCR 5X60MM 2026086 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III TI CANN SCR 5X60MM 2026086 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X80MM 20MM TI CANNULATED SCREW 2026099 CDM 278 RC facility both 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X80MM 20MM TI CANNULATED SCREW 2026099 CDM 278 RC facility both 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X90MM 20MM TI CANNULATED SCREW 2026101 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X90MM 20MM TI CANNULATED SCREW 2026101 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X105MM TI CANNULATED SCREW 602705 2026105 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X105MM TI CANNULATED SCREW 602705 2026105 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X115MM TI CANNULATED SCREW 602715 2026107 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X115MM TI CANNULATED SCREW 602715 2026107 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X120MM TI CANNULATED SCREW 602720 2026108 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X120MM TI CANNULATED SCREW 602720 2026108 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X55MM TI CANNULATED SCREW 602855 2026109 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X55MM TI CANNULATED SCREW 602855 2026109 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X60MM TI CANNULATED SCREW 602860 2026110 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X60MM TI CANNULATED SCREW 602860 2026110 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X80MM PART THREAD 40MMTI CANN SCREW 2026114 CDM 278 RC facility both 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X80MM PART THREAD 40MMTI CANN SCREW 2026114 CDM 278 RC facility both 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X14MM TI CANNULATED SCREW 2026123 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X14MM TI CANNULATED SCREW 2026123 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X16MM TI CANNULATED SCREW 2026124 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X16MM TI CANNULATED SCREW 2026124 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X18MM TI CANNULATED SCREW 2026125 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X18MM TI CANNULATED SCREW 2026125 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X20MM TI CANNULATED SCREW 2026126 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X20MM TI CANNULATED SCREW 2026126 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X22MM TI CANNULATED SCREW 2026127 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X22MM TI CANNULATED SCREW 2026127 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X24MM TI CANNULATED SCREW 2026128 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X24MM TI CANNULATED SCREW 2026128 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X26MM TI CANNULATED SCREW 2026129 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X26MM TI CANNULATED SCREW 2026129 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X28MM TI CANNULATED SCREW 2026130 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X28MM TI CANNULATED SCREW 2026130 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X30MM TI CANNULATED SCREW 2026131 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X30MM TI CANNULATED SCREW 2026131 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X32MM TI CANNULATED SCREW 2026132 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X32MM TI CANNULATED SCREW 2026132 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X34MM TI CANNULATED SCREW 2026133 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X34MM TI CANNULATED SCREW 2026133 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X36MM TI CANNULATED SCREW 2026134 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X36MM TI CANNULATED SCREW 2026134 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X38MM TI CANNULATED SCREW 2026135 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X38MM TI CANNULATED SCREW 2026135 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X40MM TI CANNULATED SCREW 2026136 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X40MM TI CANNULATED SCREW 2026136 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X42MM TI CANNULATED SCREW 2026137 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X42MM TI CANNULATED SCREW 2026137 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X44MM TI CANNULATED SCREW 2026138 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X44MM TI CANNULATED SCREW 2026138 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X46MM TI CANNULATED SCREW 2026139 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X46MM TI CANNULATED SCREW 2026139 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X48MM TI CANNULATED SCREW 2026140 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X48MM TI CANNULATED SCREW 2026140 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X50MM TI CANNULATED SCREW 2026141 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X50MM TI CANNULATED SCREW 2026141 CDM 278 RC facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X55MM TI CANNULATED SCREW 2026142 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X55MM TI CANNULATED SCREW 2026142 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X60MM TI CANNULATED SCREW 2026143 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X60MM TI CANNULATED SCREW 2026143 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X65MM TI CANNULATED SCREW 2026144 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X65MM TI CANNULATED SCREW 2026144 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X70MM TI CANNULATED SCREW 2026145 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0X70MM TI CANNULATED SCREW 2026145 CDM 278 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 4MMCANCELLOUSTISCREW 04.0MM/L48MM/FULL T 2026163 CDM 278 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price 4MMCANCELLOUSTISCREW 04.0MM/L48MM/FULL T 2026163 CDM 278 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price 4MMCANCELLOUSTISCREW 04.0MM/L16MM/TL6MM 2026170 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price 4MMCANCELLOUSTISCREW 04.0MM/L16MM/TL6MM 2026170 CDM 278 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price 6MMCANCELLOUSTISCREW 06.0MM/L20MM/FULL T 2026192 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price 6MMCANCELLOUSTISCREW 06.0MM/L20MM/FULL T 2026192 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price 6MMCANCELLOUSTISCREW 06.0MM/L85MM/TL16MM 2026219 CDM 272 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price 6MMCANCELLOUSTISCREW 06.0MM/L85MM/TL16MM 2026219 CDM 272 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X40MM TI CANNULATED SCREW 2026233 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X40MM TI CANNULATED SCREW 2026233 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X45MM TI CANNULATED SCREW 2026234 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X45MM TI CANNULATED SCREW 2026234 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X50MM TI CANNULATED SCREW 2026235 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X50MM TI CANNULATED SCREW 2026235 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X55MM TI CANNULATED SCREW 2026236 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X55MM TI CANNULATED SCREW 2026236 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X60MM TI CANNULATED SCREW 2026237 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X60MM TI CANNULATED SCREW 2026237 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X65MM TI CANNULATED SCREW 2026238 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X65MM TI CANNULATED SCREW 2026238 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X70MM TI CANNULATED SCREW 2026239 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X70MM TI CANNULATED SCREW 2026239 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X75MM TI CANNULATED SCREW 2026240 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X75MM TI CANNULATED SCREW 2026240 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X80MM TI CANNULATED SCREW 2026241 CDM 278 RC facility both 1542 1542 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X80MM TI CANNULATED SCREW 2026241 CDM 278 RC facility both 1542 1542 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X85MM TI CANNULATED SCREW 2026242 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X85MM TI CANNULATED SCREW 2026242 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X90MM TI CANNULATED SCREW 2026243 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X90MM TI CANNULATED SCREW 2026243 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X95MM TI CANNULATED SCREW 2026244 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X95MM TI CANNULATED SCREW 2026244 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X100MM TI CANNULATED SCREW 2026245 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X100MM TI CANNULATED SCREW 2026245 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X105MM TI CANNULATED SCREW 2026246 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X105MM TI CANNULATED SCREW 2026246 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X110MM TI CANNULATED SCREW 2026247 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X110MM TI CANNULATED SCREW 2026247 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X115MM TI CANNULATED SCREW 2026248 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X115MM TI CANNULATED SCREW 2026248 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X120MM TI CANNULATED SCREW 2026249 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 8.0X120MM TI CANNULATED SCREW 2026249 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X8MM" 2026250 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X8MM" 2026250 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X10MM" 2026251 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X10MM" 2026251 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X12MM" 2026252 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X12MM" 2026252 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X14MM" 2026253 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X14MM" 2026253 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X16MM" 2026254 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X16MM" 2026254 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X20MM" 2026256 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X20MM" 2026256 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X22MM" 2026257 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X22MM" 2026257 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X24MM" 2026258 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X24MM" 2026258 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X26MM" 2026259 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X26MM" 2026259 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X28MM" 2026260 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X28MM" 2026260 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X30MM" 2026261 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 2.7X30MM" 2026261 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X08MM" 2026276 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X08MM" 2026276 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X10MM" 2026277 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X10MM" 2026277 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X12MM" 2026278 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X12MM" 2026278 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X14MM" 2026279 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X14MM" 2026279 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X16MM" 2026280 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X16MM" 2026280 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X18MM" 2026281 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X18MM" 2026281 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X20MM" 2026282 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X20MM" 2026282 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X22MM" 2026283 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X22MM" 2026283 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X24MM" 2026284 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X24MM" 2026284 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X26MM" 2026285 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X26MM" 2026285 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X28MM" 2026286 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X28MM" 2026286 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X30MM" 2026287 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X30MM" 2026287 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X32MM" 2026288 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X32MM" 2026288 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X34MM" 2026289 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X34MM" 2026289 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X36MM" 2026290 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X36MM" 2026290 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X38MM" 2026291 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X38MM" 2026291 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT LOCKING MED 04.3X296MM 2026292 CDM 278 RC facility both 968 968 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT LOCKING MED 04.3X296MM 2026292 CDM 278 RC facility both 968 968 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L95MM 2026302 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L95MM 2026302 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5X125MM(GOLD) 2026304 CDM 272 RC facility both 284 284 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5X125MM(GOLD) 2026304 CDM 272 RC facility both 284 284 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.7X125MM 2026305 CDM 272 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.7X125MM 2026305 CDM 272 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2MM/L180MM AO/CALIB 2026308 CDM 272 RC facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2MM/L180MM AO/CALIB 2026308 CDM 272 RC facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2MM/L145MM AO 2026309 CDM 272 RC facility both 662 662 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2MM/L145MM AO 2026309 CDM 272 RC facility both 662 662 Gross Charge Type: NIHD_Hosp_Profee_Price CANN 2.7MM TWIST DRILL W/ AO F 2026310 CDM 272 RC facility both 691 691 Gross Charge Type: NIHD_Hosp_Profee_Price CANN 2.7MM TWIST DRILL W/ AO F 2026310 CDM 272 RC facility both 691 691 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III 1.4X150MM GUIDE WIRE 2026311 CDM 272 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III 1.4X150MM GUIDE WIRE 2026311 CDM 272 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III THREADED GUIDE WIRE 3.2X300MM 2026312 CDM 272 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III THREADED GUIDE WIRE 3.2X300MM 2026312 CDM 272 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL CANNULATED 4.9MM AO FIT 2026313 CDM 272 RC facility both 1007 1007 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL CANNULATED 4.9MM AO FIT 2026313 CDM 272 RC facility both 1007 1007 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III CANNULATED DRILL 8.0MM LG AO 2026316 CDM 278 RC facility both 1976 1976 Gross Charge Type: NIHD_Hosp_Profee_Price ASNIS III CANNULATED DRILL 8.0MM LG AO 2026316 CDM 278 RC facility both 1976 1976 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.3X125MM 2026318 CDM 272 RC facility both 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.3X125MM 2026318 CDM 272 RC facility both 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.1MM X 204MM 2026319 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.1MM X 204MM 2026319 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.3X262MM 2026320 CDM 278 RC facility both 357 357 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.3X262MM 2026320 CDM 278 RC facility both 357 357 Gross Charge Type: NIHD_Hosp_Profee_Price "DRILL, 2.0MMX122MM, WL50MM, AO-SHAFT" 2026327 CDM 272 RC facility both 329 329 Gross Charge Type: NIHD_Hosp_Profee_Price "DRILL, 2.0MMX122MM, WL50MM, AO-SHAFT" 2026327 CDM 272 RC facility both 329 329 Gross Charge Type: NIHD_Hosp_Profee_Price "DRILL, 2.6MMX122MM, WL70MM, AO-SHAFT" 2026328 CDM 272 RC facility both 329 329 Gross Charge Type: NIHD_Hosp_Profee_Price "DRILL, 2.6MMX122MM, WL70MM, AO-SHAFT" 2026328 CDM 272 RC facility both 329 329 Gross Charge Type: NIHD_Hosp_Profee_Price OVERDRILL 2.7DIA FOR LAGGING SCREWS 2026329 CDM 272 RC facility both 329 329 Gross Charge Type: NIHD_Hosp_Profee_Price OVERDRILL 2.7DIA FOR LAGGING SCREWS 2026329 CDM 272 RC facility both 329 329 Gross Charge Type: NIHD_Hosp_Profee_Price OVERDRILL 3.5DIA FOR LAGGING SCREWS 2026330 CDM 278 RC facility both 593 593 Gross Charge Type: NIHD_Hosp_Profee_Price OVERDRILL 3.5DIA FOR LAGGING SCREWS 2026330 CDM 278 RC facility both 593 593 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA+2.8MM THREADED TIP GUIDE PIN 230MM 2026333 CDM 272 RC facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price OMEGA+2.8MM THREADED TIP GUIDE PIN 230MM 2026333 CDM 272 RC facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE WITH DRILL TIP 02.0X234MM 2026334 CDM 272 RC facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE WITH DRILL TIP 02.0X234MM 2026334 CDM 272 RC facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5X216MM NONLOCKING SHORT 2026335 CDM 272 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5X216MM NONLOCKING SHORT 2026335 CDM 272 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT LOCKING SHORT 03.1X216MM 2026336 CDM 272 RC facility both 615 615 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT LOCKING SHORT 03.1X216MM 2026336 CDM 272 RC facility both 615 615 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT LOCKING SHORT 03.2X216MM 2026337 CDM 278 RC facility both 992 992 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT LOCKING SHORT 03.2X216MM 2026337 CDM 278 RC facility both 992 992 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT LOCKING SHORT 04.3X216MM 2026339 CDM 278 RC facility both 979 979 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT LOCKING SHORT 04.3X216MM 2026339 CDM 278 RC facility both 979 979 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L50MM 2026340 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L50MM 2026340 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L55MM 2026341 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L55MM 2026341 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L60MM 2026342 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L60MM 2026342 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L65MM 2026343 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L65MM 2026343 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L95MM 2026349 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L95MM 2026349 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L14MM 2026350 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L14MM 2026350 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L16MM 2026351 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L16MM 2026351 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L18MM 2026352 CDM 278 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L18MM 2026352 CDM 278 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L20MM 2026353 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L20MM 2026353 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L22MM 2026354 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L22MM 2026354 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L24MM 2026355 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L24MM 2026355 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L26MM 2026356 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L26MM 2026356 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L28MM 2026357 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L28MM 2026357 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L30MM 2026358 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L30MM 2026358 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L32MM 2026359 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L32MM 2026359 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L34MM 2026360 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L34MM 2026360 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L36MM 2026361 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L36MM 2026361 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L38MM 2026362 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L38MM 2026362 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L40MM 2026363 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L40MM 2026363 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L42MM 2026364 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L42MM 2026364 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L44MM 2026365 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L44MM 2026365 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L46MM 2026366 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L46MM 2026366 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L48MM 2026367 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L48MM 2026367 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L50MM 2026368 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L50MM 2026368 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L55MM 2026369 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L55MM 2026369 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L60MM 2026370 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L60MM 2026370 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L65MM 2026371 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L65MM 2026371 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L70MM 2026372 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L70MM 2026372 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L75MM 2026373 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L75MM 2026373 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L80MM 2026374 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L80MM 2026374 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L85MM 2026375 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L85MM 2026375 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L90MM 2026376 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 4.5MM CORTEX TI SCREW 04.5MM/L90MM 2026376 CDM 278 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L48MM 2026378 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L48MM 2026378 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L50MM 2026379 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L50MM 2026379 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L55MM 2026380 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L55MM 2026380 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L60MM 2026381 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L60MM 2026381 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L65MM 2026382 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L65MM 2026382 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L70MM 2026383 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L70MM 2026383 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L75MM 2026384 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L75MM 2026384 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L80MM 2026385 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L80MM 2026385 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L85MM 2026386 CDM 278 RC facility both 459 459 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L85MM 2026386 CDM 278 RC facility both 459 459 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L8MM 2026389 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L8MM 2026389 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L10MM 2026390 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L10MM 2026390 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L12MM 2026391 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L12MM 2026391 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L14MM 2026392 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L14MM 2026392 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L16MM 2026393 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L16MM 2026393 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L18MM 2026394 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L18MM 2026394 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L20MM 2026395 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPROSTHETIC LOCKING SCREW 5.0MM/L20MM 2026395 CDM 278 RC facility both 748 748 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L14MM 2026396 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L14MM 2026396 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L16MM 2026397 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L16MM 2026397 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L18MM 2026398 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L18MM 2026398 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L20MM 2026399 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L20MM 2026399 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L22MM 2026400 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L22MM 2026400 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L24MM 2026401 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L24MM 2026401 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L26MM 2026402 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L26MM 2026402 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L28MM 2026403 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L28MM 2026403 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L30MM 2026404 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L30MM 2026404 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L32MM 2026405 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L32MM 2026405 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L34MM 2026406 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L34MM 2026406 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L36MM 2026407 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L36MM 2026407 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L38MM 2026408 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L38MM 2026408 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L40MM 2026409 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L40MM 2026409 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L42MM 2026410 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L42MM 2026410 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L44MM 2026411 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L44MM 2026411 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L46MM 2026412 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L46MM 2026412 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L48MM 2026413 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L48MM 2026413 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L28MM TITANIUM 2026414 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L28MM TITANIUM 2026414 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L30MM TITANIUM 2026415 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L30MM TITANIUM 2026415 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L32MM TITANIUM 2026416 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L32MM TITANIUM 2026416 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L34MM TITANIUM 2026417 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L34MM TITANIUM 2026417 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L36MM TITANIUM 2026418 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L36MM TITANIUM 2026418 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L38MM TITANIUM 2026419 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L38MM TITANIUM 2026419 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L40MM TITANIUM 2026420 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L40MM TITANIUM 2026420 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L42MM TITANIUM 2026421 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L42MM TITANIUM 2026421 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L44MM TITANIUM 2026422 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L44MM TITANIUM 2026422 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L46MM TITANIUM 2026423 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L46MM TITANIUM 2026423 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L48MM TITANIUM 2026424 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L48MM TITANIUM 2026424 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L50MM TITANIUM 2026425 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L50MM TITANIUM 2026425 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L55MM TITIANIUM 2026426 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L55MM TITIANIUM 2026426 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L60MM 2026427 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L60MM 2026427 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L65MM TITANIUM 2026428 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L65MM TITANIUM 2026428 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L70MM TITANIUM 2026429 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L70MM TITANIUM 2026429 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L75MM TITANIUM 2026430 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L75MM TITANIUM 2026430 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L80MM TITANIUM 2026431 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L80MM TITANIUM 2026431 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L85MM TITANIUM 2026432 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L85MM TITANIUM 2026432 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L90MM TITANIUM 2026433 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L90MM TITANIUM 2026433 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L95MM 2026434 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L95MM 2026434 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L20MM 2026438 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L20MM 2026438 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L28MM 2026442 CDM 278 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L28MM 2026442 CDM 278 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L30MM 2026443 CDM 278 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L30MM 2026443 CDM 278 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L34MM 2026445 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L34MM 2026445 CDM 278 RC facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L36MM 2026446 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L36MM 2026446 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L38MM 2026447 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L38MM 2026447 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L40MM 2026448 CDM 278 RC facility both 459 459 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L40MM 2026448 CDM 278 RC facility both 459 459 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L42MM 2026449 CDM 278 RC facility both 459 459 Gross Charge Type: NIHD_Hosp_Profee_Price 5MM LOCKING SCREW 5.0MM/L42MM 2026449 CDM 278 RC facility both 459 459 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 6 HOLE/ RIGHT 2026451 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 6 HOLE/ RIGHT 2026451 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 8 HOLE/ RIGHT 2026452 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 8 HOLE/ RIGHT 2026452 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 4 HOLE 2026453 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 4 HOLE 2026453 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 6 HOLE 2026454 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 6 HOLE 2026454 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 8 HOLE 2026455 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 8 HOLE 2026455 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATE,NARROW, STR,4HOLE" 2026456 CDM 278 RC facility both 1238 1238 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATE,NARROW, STR,4HOLE" 2026456 CDM 278 RC facility both 1238 1238 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATE,NARROW, STR,5HOLE" 2026457 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATE,NARROW, STR,5HOLE" 2026457 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATE,NARROW, STR,6HOLE" 2026458 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATE,NARROW, STR,6HOLE" 2026458 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAXCOMPRESSIONPLATE 7HOLE/L90W/2LOCK 2026459 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAXCOMPRESSIONPLATE 7HOLE/L90W/2LOCK 2026459 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATENARROW,STR,8HOLES" 2026460 CDM 278 RC facility both 2410 2410 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATENARROW,STR,8HOLES" 2026460 CDM 278 RC facility both 2410 2410 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATENARROW,STR,9HOLES" 2026461 CDM 278 RC facility both 2410 2410 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATENARROW,STR,9HOLES" 2026461 CDM 278 RC facility both 2410 2410 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATENARROW,STR,10HOLES" 2026462 CDM 278 RC facility both 2410 2410 Gross Charge Type: NIHD_Hosp_Profee_Price "VARIAXCOMPRESSIONPLATENARROW,STR,10HOLES" 2026462 CDM 278 RC facility both 2410 2410 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAXCOMPRESSIONPLATE7HOLE/L90MMW/4LOCK 2026463 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAXCOMPRESSIONPLATE7HOLE/L90MMW/4LOCK 2026463 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAXCOMPRESSIONPLATE7HOLE/L91MMW/4LOCK 2026464 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAXCOMPRESSIONPLATE7HOLE/L91MMW/4LOCK 2026464 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAXCOMPRESSIONPLATE7HOLE/L91MMW/2LOCK 2026468 CDM 278 RC facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAXCOMPRESSIONPLATE7HOLE/L91MMW/2LOCK 2026468 CDM 278 RC facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L14MM TITANIUM 2026475 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L14MM TITANIUM 2026475 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L16MM TITANIUM 2026476 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L16MM TITANIUM 2026476 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L18MM TITANIUM 2026477 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L18MM TITANIUM 2026477 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L20MM TITANIUM 2026478 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L20MM TITANIUM 2026478 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L22MM TITANIUM 2026479 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L22MM TITANIUM 2026479 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L24MM TITANIUM 2026480 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L24MM TITANIUM 2026480 CDM 278 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L26MM TITANIUM 2026481 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM LOCKING SCREW 4.0MM/L26MM TITANIUM 2026481 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR LATERAL PLATE-7HOLE/LEFT 2026482 CDM 278 RC facility both 5253 5253 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR LATERAL PLATE-7HOLE/LEFT 2026482 CDM 278 RC facility both 5253 5253 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR MIDSHAFT PLATE-6 HOLE 2026487 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR MIDSHAFT PLATE-6 HOLE 2026487 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR MIDSHAFT PLATE-7 HOLE 2026488 CDM facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR MIDSHAFT PLATE-7 HOLE 2026488 CDM facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR MIDSHAFT PLATE-8 HOLE 2026489 CDM 278 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR MIDSHAFT PLATE-8 HOLE 2026489 CDM 278 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR MIDSHAFT PLATE-10 HOLE 2026490 CDM 278 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR MIDSHAFT PLATE-10 HOLE 2026490 CDM 278 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 4 HOLE/LEFT 2026494 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 4 HOLE/LEFT 2026494 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 6 HOLE/LEFT 2026495 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 6 HOLE/LEFT 2026495 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 8 HOLE/LEFT 2026496 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 8 HOLE/LEFT 2026496 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 4HOLE/RIGHT 2026497 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 4HOLE/RIGHT 2026497 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 6HOLE/RIGHT 2026498 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 6HOLE/RIGHT 2026498 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 8HOLE/RIGHT 2026499 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL LATERAL HUMERUS PLATE 8HOLE/RIGHT 2026499 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 4HOLE EXTEND 2026506 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 4HOLE EXTEND 2026506 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 6HOLE EXTEND 2026507 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 6HOLE EXTEND 2026507 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 8HOLE EXTEND 2026508 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL MEDIAL HUMERUS PLATE 8HOLE EXTEND 2026508 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 4 HOLE/LEFT 2026515 CDM 278 RC facility both 2691 2691 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 4 HOLE/LEFT 2026515 CDM 278 RC facility both 2691 2691 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 6 HOLE/LEFT 2026516 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 6 HOLE/LEFT 2026516 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 8 HOLE/LEFT 2026517 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 8 HOLE/LEFT 2026517 CDM 278 RC facility both 5058 5058 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 4 HOLE/RIGHT 2026518 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price OLECRANON PLATE 4 HOLE/RIGHT 2026518 CDM 278 RC facility both 3966 3966 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA4HOLE/L71MM 2026525 CDM facility both 5484 5484 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA4HOLE/L71MM 2026525 CDM facility both 5484 5484 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORRIGHTTIBIA6HOLE/L97MM 2026531 CDM facility both 3265 3265 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORRIGHTTIBIA6HOLE/L97MM 2026531 CDM facility both 3265 3265 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-6HOLE/LEFT 2026533 CDM 278 RC facility both 2651 2651 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-6HOLE/LEFT 2026533 CDM 278 RC facility both 2651 2651 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-7HOLE/LEFT 2026534 CDM 278 RC facility both 2651 2651 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-7HOLE/LEFT 2026534 CDM 278 RC facility both 2651 2651 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-8HOLE/LEFT 2026535 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-8HOLE/LEFT 2026535 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-10HOLE/LEFT 2026536 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-10HOLE/LEFT 2026536 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-7HOLE/RIGHT 2026538 CDM 278 RC facility both 2651 2651 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-7HOLE/RIGHT 2026538 CDM 278 RC facility both 2651 2651 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-8HOLE/RIGHT 2026539 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-8HOLE/RIGHT 2026539 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-10HOLE/RIGHT 2026540 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-10HOLE/RIGHT 2026540 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEDECREASED-6HOLE/BRIDGE LEFT 2026541 CDM 278 RC facility both 658 658 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEDECREASED-6HOLE/BRIDGE LEFT 2026541 CDM 278 RC facility both 658 658 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEDECREASED-8HOLE/BRIDGE LEFT 2026542 CDM 278 RC facility both 658 658 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEDECREASED-8HOLE/BRIDGE LEFT 2026542 CDM 278 RC facility both 658 658 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEDECREASED-6HOLE/BRIDGERIGHT 2026543 CDM 278 RC facility both 658 658 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEDECREASED-6HOLE/BRIDGERIGHT 2026543 CDM 278 RC facility both 658 658 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEDECREASED-8HOLE/BRIDGERIGHT 2026544 CDM 278 RC facility both 658 658 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEDECREASED-8HOLE/BRIDGERIGHT 2026544 CDM 278 RC facility both 658 658 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE INCREASED - 8 HOLE/LEFT 2026545 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE INCREASED - 8 HOLE/LEFT 2026545 CDM 278 RC facility both 2946 2946 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEINCREASED-6HOLE/BRIDGELEFT 2026549 CDM facility both 4682 4682 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIORPLATEINCREASED-6HOLE/BRIDGELEFT 2026549 CDM facility both 4682 4682 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA4HOLE/L121MM 2026556 CDM facility both 6291 6291 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA4HOLE/L121MM 2026556 CDM facility both 6291 6291 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA6HOLE/L147MM 2026557 CDM 278 RC facility both 760 760 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA6HOLE/L147MM 2026557 CDM 278 RC facility both 760 760 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA8HOLE/L173MM 2026558 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA8HOLE/L173MM 2026558 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA10HOLE/L199MM 2026559 CDM 278 RC facility both 396 396 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA10HOLE/L199MM 2026559 CDM 278 RC facility both 396 396 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA12HOLE/L225MM 2026560 CDM 278 RC facility both 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA12HOLE/L225MM 2026560 CDM 278 RC facility both 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA14HOLE/L251MM 2026561 CDM 278 RC facility both 412 412 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA14HOLE/L251MM 2026561 CDM 278 RC facility both 412 412 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA8HOLE/L149MM 2026571 CDM 278 RC facility both 6304 6304 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORLEFTTIBIA8HOLE/L149MM 2026571 CDM 278 RC facility both 6304 6304 Gross Charge Type: NIHD_Hosp_Profee_Price FEMURPLATEFORLEFTFEMUR4HOLE/L130MM 2026585 CDM 278 RC facility both 7455 7455 Gross Charge Type: NIHD_Hosp_Profee_Price FEMURPLATEFORLEFTFEMUR4HOLE/L130MM 2026585 CDM 278 RC facility both 7455 7455 Gross Charge Type: NIHD_Hosp_Profee_Price FEMURPLATEFORLEFTFEMUR8HOLE/L202MM 2026587 CDM 278 RC facility both 5586 5586 Gross Charge Type: NIHD_Hosp_Profee_Price FEMURPLATEFORLEFTFEMUR8HOLE/L202MM 2026587 CDM 278 RC facility both 5586 5586 Gross Charge Type: NIHD_Hosp_Profee_Price FEMURPLATEFORLEFTFEMUR14HOLE/L310MM 2026590 CDM 278 RC facility both 8323 8323 Gross Charge Type: NIHD_Hosp_Profee_Price FEMURPLATEFORLEFTFEMUR14HOLE/L310MM 2026590 CDM 278 RC facility both 8323 8323 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X12MM" 2026595 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X12MM" 2026595 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X14MM" 2026596 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X14MM" 2026596 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X16MM" 2026597 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X16MM" 2026597 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X18MM" 2026598 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X18MM" 2026598 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X20MM" 2026599 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X20MM" 2026599 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X22MM" 2026600 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X22MM" 2026600 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X24MM" 2026601 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X24MM" 2026601 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X26MM" 2026602 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X26MM" 2026602 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X28MM" 2026603 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X28MM" 2026603 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X30MM" 2026604 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X30MM" 2026604 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X32MM" 2026605 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X32MM" 2026605 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X34MM" 2026606 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X34MM" 2026606 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X36MM" 2026607 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X36MM" 2026607 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X38MM" 2026608 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X38MM" 2026608 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X40MM" 2026609 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X40MM" 2026609 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X44MM" 2026611 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X44MM" 2026611 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price TI ASNIS III WASHER FOR 6.5/8.0MM SCREWS 2026619 CDM 278 RC facility both 154 154 Gross Charge Type: NIHD_Hosp_Profee_Price TI ASNIS III WASHER FOR 6.5/8.0MM SCREWS 2026619 CDM 278 RC facility both 154 154 Gross Charge Type: NIHD_Hosp_Profee_Price TI ASNIS III WASHER 4.0MM 2026620 CDM 278 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price TI ASNIS III WASHER 4.0MM 2026620 CDM 278 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price TI ASNIS III WASHER 5.0MM 2026621 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price TI ASNIS III WASHER 5.0MM 2026621 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 3 HOLE 2026622 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 3 HOLE 2026622 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 4 HOLE 2026623 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 4 HOLE 2026623 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 5 HOLE 2026624 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 5 HOLE 2026624 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 6 HOLE 2026625 CDM 278 RC facility both 6677 6677 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 6 HOLE 2026625 CDM 278 RC facility both 6677 6677 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 3 HOLE 2026626 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 3 HOLE 2026626 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 4 HOLE 2026627 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 4 HOLE 2026627 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 5 HOLE 2026628 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 5 HOLE 2026628 CDM 278 RC facility both 5785 5785 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 6 HOLE 2026629 CDM 278 RC facility both 6677 6677 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 6 HOLE 2026629 CDM 278 RC facility both 6677 6677 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIA PLATE FOR LEFT TIBIA 2 HOLE/L95MM 2026630 CDM facility both 6160 6160 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIA PLATE FOR LEFT TIBIA 2 HOLE/L95MM 2026630 CDM facility both 6160 6160 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X40MM" 2026631 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X40MM" 2026631 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X42MM" 2026632 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X42MM" 2026632 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X44MM" 2026633 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X44MM" 2026633 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X46MM" 2026634 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X46MM" 2026634 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X48MM" 2026635 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X48MM" 2026635 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X50MM" 2026636 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X50MM" 2026636 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X55MM" 2026637 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X55MM" 2026637 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X60MM" 2026638 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X60MM" 2026638 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X65MM" 2026639 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X65MM" 2026639 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X70MM" 2026640 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCKING SCREW, T10, 3.5X70MM" 2026640 CDM 278 RC facility both 666 666 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X8MM" 2026641 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X8MM" 2026641 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X10MM" 2026642 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X10MM" 2026642 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X12MM" 2026643 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X12MM" 2026643 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X14MM" 2026644 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X14MM" 2026644 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X16MM" 2026645 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X16MM" 2026645 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X18MM" 2026646 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X18MM" 2026646 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X20MM" 2026647 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X20MM" 2026647 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X22MM" 2026648 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X22MM" 2026648 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X24MM" 2026649 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X24MM" 2026649 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X26MM" 2026650 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X26MM" 2026650 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X28MM" 2026651 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X28MM" 2026651 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X30MM" 2026652 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X30MM" 2026652 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X32MM" 2026653 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X32MM" 2026653 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X34MM" 2026654 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X34MM" 2026654 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X36MM" 2026655 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X36MM" 2026655 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X38MM" 2026656 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X38MM" 2026656 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X40MM" 2026657 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X40MM" 2026657 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X42MM" 2026658 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X42MM" 2026658 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X44MM" 2026659 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X44MM" 2026659 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X46MM" 2026660 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X46MM" 2026660 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X48MM" 2026661 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X48MM" 2026661 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X50MM" 2026662 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X50MM" 2026662 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X55MM" 2026663 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X55MM" 2026663 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X60MM" 2026664 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X60MM" 2026664 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X65MM" 2026665 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X65MM" 2026665 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X70MM" 2026666 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 2.7X70MM" 2026666 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X8MM" 2026667 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price "BONE SCREW, T10, 3.5X8MM" 2026667 CDM 278 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X36MM 2026669 CDM 278 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 3.5X36MM 2026669 CDM 278 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L75MM 2026671 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L75MM 2026671 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L80MM 2026672 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L80MM 2026672 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L85MM 2026673 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM CORTEX TI SCREW 03.5MM/L85MM 2026673 CDM 278 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULATED DRILL 6.5MM LG AO FITTING 2026675 CDM 278 RC facility both 2011 2011 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULATED DRILL 6.5MM LG AO FITTING 2026675 CDM 278 RC facility both 2011 2011 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 8 HOLE 2026684 CDM 278 RC facility both 6677 6677 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 8 HOLE 2026684 CDM 278 RC facility both 6677 6677 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 12 HOLE 2026686 CDM 278 RC facility both 5619 5619 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR LEFT HUMERUS 12 HOLE 2026686 CDM 278 RC facility both 5619 5619 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 8 HOLE 2026687 CDM 278 RC facility both 6677 6677 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 8 HOLE 2026687 CDM 278 RC facility both 6677 6677 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 10 HOLE 2026688 CDM 278 RC facility both 5619 5619 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 10 HOLE 2026688 CDM 278 RC facility both 5619 5619 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 12 HOLE 2026689 CDM 278 RC facility both 5619 5619 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERUS PLATE FOR RIGHT HUMERUS 12 HOLE 2026689 CDM 278 RC facility both 5619 5619 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL CANNULATED 4.0MM WITH AO COUPLING 2026700 CDM 272 RC facility both 716 716 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL CANNULATED 4.0MM WITH AO COUPLING 2026700 CDM 272 RC facility both 716 716 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 3.0X14.5MM W/ #2 TIGERTAILS 2026706 CDM 272 RC facility both 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 3.0X14.5MM W/ #2 TIGERTAILS 2026706 CDM 272 RC facility both 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 3.O WITH #2 FIBERWIRE 2026707 CDM 272 RC facility both 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 3.O WITH #2 FIBERWIRE 2026707 CDM 272 RC facility both 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 8X4MM 2026708 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 8X4MM 2026708 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 10MMX3CM 2026710 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 10MMX3CM 2026710 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 10X4MM 2026711 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 10X4MM 2026711 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 1.3MM WHITE/BLUE SUTURE TAPE 2026716 CDM 272 RC facility both 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 1.3MM WHITE/BLUE SUTURE TAPE 2026716 CDM 272 RC facility both 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE DALL-MILES BEADED 2.0MM/SLEEVE SET 2026717 CDM 278 RC facility both 1815 1815 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE DALL-MILES BEADED 2.0MM/SLEEVE SET 2026717 CDM 278 RC facility both 1815 1815 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE DALL-MILES 1.6MM HOLES SLEEVE 2026718 CDM 278 RC facility both 1083 1083 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE DALL-MILES 1.6MM HOLES SLEEVE 2026718 CDM 278 RC facility both 1083 1083 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DALL-MILES TROC GRIP MED 200MM 2026719 CDM 278 RC facility both 11595 11595 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DALL-MILES TROC GRIP MED 200MM 2026719 CDM 278 RC facility both 11595 11595 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DALL-MILES TROC GRIP MED 100MM 2026720 CDM 278 RC facility both 7137 7137 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DALL-MILES TROC GRIP MED 100MM 2026720 CDM 278 RC facility both 7137 7137 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DALL-MILES TROC GRIP MED 150MM 2026721 CDM 278 RC facility both 5145 5145 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DALL-MILES TROC GRIP MED 150MM 2026721 CDM 278 RC facility both 5145 5145 Gross Charge Type: NIHD_Hosp_Profee_Price ADVANTAGE FIT SYSTEM (TVT) 2026746 CDM 278 RC facility both 3490 3490 Gross Charge Type: NIHD_Hosp_Profee_Price ADVANTAGE FIT SYSTEM (TVT) 2026746 CDM 278 RC facility both 3490 3490 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE KEYLESS STD BARREL 2026793 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE KEYLESS STD BARREL 2026793 CDM 278 RC facility both 2452 2452 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEPIN 2026795 CDM 272 RC facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEPIN 2026795 CDM 272 RC facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW AXNIS 111 CANNULATED 6.5X20X90MM 2026797 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW AXNIS 111 CANNULATED 6.5X20X90MM 2026797 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price HALFPIN 4.5 THREADED 40X150MM 2026799 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price HALFPIN 4.5 THREADED 40X150MM 2026799 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price HALFPIN 4.5 THREADED 30X150MM 2026800 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price HALFPIN 4.5 THREADED 30X150MM 2026800 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price HALFPIN 4.5 THREADED 20X150MM 2026801 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price HALFPIN 4.5 THREADED 20X150MM 2026801 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price DRILLTIP WIRE 1.8X385MM 2026802 CDM 272 RC facility both 735 735 Gross Charge Type: NIHD_Hosp_Profee_Price DRILLTIP WIRE 1.8X385MM 2026802 CDM 272 RC facility both 735 735 Gross Charge Type: NIHD_Hosp_Profee_Price DRILLTIP WIRE WITH STOPPER 1.8X385MM 2026803 CDM 272 RC facility both 1103 1103 Gross Charge Type: NIHD_Hosp_Profee_Price DRILLTIP WIRE WITH STOPPER 1.8X385MM 2026803 CDM 272 RC facility both 1103 1103 Gross Charge Type: NIHD_Hosp_Profee_Price RING 2/3 180MM ILIZ0V 2026804 CDM 272 RC facility both 5517 5517 Gross Charge Type: NIHD_Hosp_Profee_Price RING 2/3 180MM ILIZ0V 2026804 CDM 272 RC facility both 5517 5517 Gross Charge Type: NIHD_Hosp_Profee_Price RING FULL 180MM ILIZ0V 2026805 CDM 272 RC facility both 5773 5773 Gross Charge Type: NIHD_Hosp_Profee_Price RING FULL 180MM ILIZ0V 2026805 CDM 272 RC facility both 5773 5773 Gross Charge Type: NIHD_Hosp_Profee_Price RING FOOT 180MM LONG ILIZ0V 2026806 CDM 272 RC facility both 5593 5593 Gross Charge Type: NIHD_Hosp_Profee_Price RING FOOT 180MM LONG ILIZ0V 2026806 CDM 272 RC facility both 5593 5593 Gross Charge Type: NIHD_Hosp_Profee_Price RING HALF 180MM ILIZ0V 2026807 CDM 272 RC facility both 4737 4737 Gross Charge Type: NIHD_Hosp_Profee_Price RING HALF 180MM ILIZ0V 2026807 CDM 272 RC facility both 4737 4737 Gross Charge Type: NIHD_Hosp_Profee_Price FASTFIX STRUT FOR TSF MEDIUM 2026808 CDM 272 RC facility both 4551 4551 Gross Charge Type: NIHD_Hosp_Profee_Price FASTFIX STRUT FOR TSF MEDIUM 2026808 CDM 272 RC facility both 4551 4551 Gross Charge Type: NIHD_Hosp_Profee_Price FASTFIX STRUT FOR TSF LONG 2026809 CDM 272 RC facility both 4551 4551 Gross Charge Type: NIHD_Hosp_Profee_Price FASTFIX STRUT FOR TSF LONG 2026809 CDM 272 RC facility both 4551 4551 Gross Charge Type: NIHD_Hosp_Profee_Price RANCHO CUBE WITH POST 2 HOLE 2026810 CDM 272 RC facility both 984 984 Gross Charge Type: NIHD_Hosp_Profee_Price RANCHO CUBE WITH POST 2 HOLE 2026810 CDM 272 RC facility both 984 984 Gross Charge Type: NIHD_Hosp_Profee_Price RANCHO CUBE 2 HOLE 2026811 CDM 272 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price RANCHO CUBE 2 HOLE 2026811 CDM 272 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price RANCHO CUBE 4 HOLE 2026812 CDM 272 RC facility both 909 909 Gross Charge Type: NIHD_Hosp_Profee_Price RANCHO CUBE 4 HOLE 2026812 CDM 272 RC facility both 909 909 Gross Charge Type: NIHD_Hosp_Profee_Price RANCHO CUBE 5 HOLE 2026813 CDM 272 RC facility both 1007 1007 Gross Charge Type: NIHD_Hosp_Profee_Price RANCHO CUBE 5 HOLE 2026813 CDM 272 RC facility both 1007 1007 Gross Charge Type: NIHD_Hosp_Profee_Price CONNECTOR ANGLE PIN 35MM 2026814 CDM 272 RC facility both 1859 1859 Gross Charge Type: NIHD_Hosp_Profee_Price CONNECTOR ANGLE PIN 35MM 2026814 CDM 272 RC facility both 1859 1859 Gross Charge Type: NIHD_Hosp_Profee_Price NUT THICK ITALIAN 2026815 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price NUT THICK ITALIAN 2026815 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SET FOR HEX-FIX 2026816 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SET FOR HEX-FIX 2026816 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price BOLT CANNULA WITH FIX 2026817 CDM 272 RC facility both 190 190 Gross Charge Type: NIHD_Hosp_Profee_Price BOLT CANNULA WITH FIX 2026817 CDM 272 RC facility both 190 190 Gross Charge Type: NIHD_Hosp_Profee_Price HALF PIN CAP 6MM 2026819 CDM 272 RC facility both 135 135 Gross Charge Type: NIHD_Hosp_Profee_Price HALF PIN CAP 6MM 2026819 CDM 272 RC facility both 135 135 Gross Charge Type: NIHD_Hosp_Profee_Price ILIZAROV DISCLIP 5MM 2026820 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ILIZAROV DISCLIP 5MM 2026820 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BOLT 16MM 2026821 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BOLT 16MM 2026821 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price LOW PROFILE MALE HINGE 2026822 CDM 272 RC facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price LOW PROFILE MALE HINGE 2026822 CDM 272 RC facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price OVERDRILL 2.7X122MM AO STRYKER 2026834 CDM 272 RC facility both 485 485 Gross Charge Type: NIHD_Hosp_Profee_Price OVERDRILL 2.7X122MM AO STRYKER 2026834 CDM 272 RC facility both 485 485 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT RECTOPEXY BIODESIGN 7X20 2026839 CDM 278 RC facility both 3823 3823 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT RECTOPEXY BIODESIGN 7X20 2026839 CDM 278 RC facility both 3823 3823 Gross Charge Type: NIHD_Hosp_Profee_Price OSSTEOTOME THIN LONG 8X5MM 2026844 CDM 272 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price OSSTEOTOME THIN LONG 8X5MM 2026844 CDM 272 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price OSSTEOTOME THIN LONG 8X21/2MM 2026845 CDM 272 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price OSSTEOTOME THIN LONG 8X21/2MM 2026845 CDM 272 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price OSSTEOTOME RADIAL 6X5MM 2026846 CDM 272 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price OSSTEOTOME RADIAL 6X5MM 2026846 CDM 272 RC facility both 1062 1062 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE SLEEVE SET DALL-MILES 2026854 CDM 278 RC facility both 1764 1764 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE SLEEVE SET DALL-MILES 2026854 CDM 278 RC facility both 1764 1764 Gross Charge Type: NIHD_Hosp_Profee_Price PREVENA INCISION MANAGEMENT SYS 13 CM 2026863 CDM 271 RC facility both 2078 2078 Gross Charge Type: NIHD_RHC_Price PREVENA INCISION MANAGEMENT SYS 13 CM 2026863 CDM 271 RC facility both 2078 2078 Gross Charge Type: NIHD_Clinic_Price PREVENA INCISION MANAGEMENT SYS 13 CM 2026863 CDM 271 RC facility both 1159 1159 Gross Charge Type: NIHD_Hosp_Profee_Price PREVENA INCISION MANAGEMENT SYS 13 CM 2026863 CDM 271 RC facility both 1159 1159 Gross Charge Type: NIHD_Hosp_Profee_Price DRG PEEL AND PLACE PREVENA 13 ML 2026870 CDM 271 RC facility both 6805 6805 Gross Charge Type: NIHD_Hosp_Profee_Price DRG PEEL AND PLACE PREVENA 13 ML 2026870 CDM 271 RC facility both 6805 6805 Gross Charge Type: NIHD_Hosp_Profee_Price HALFPIN 4.5 THREADED 50X150MM 2026902 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price HALFPIN 4.5 THREADED 50X150MM 2026902 CDM 278 RC facility both 776 776 Gross Charge Type: NIHD_Hosp_Profee_Price NUT 10MM 2026903 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price NUT 10MM 2026903 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL STEP 3.8MM LONG 2026904 CDM 272 RC facility both 1779 1779 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL STEP 3.8MM LONG 2026904 CDM 272 RC facility both 1779 1779 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANCELLEOUS BONE TORX 6.5X40MM 2026907 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANCELLEOUS BONE TORX 6.5X40MM 2026907 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP 132DEG SZ10X35X160MM 2026909 CDM 278 RC facility both 23552 23552 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP 132DEG SZ10X35X160MM 2026909 CDM 278 RC facility both 23552 23552 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL CERAMIC 28MMX-2.5MM 2026910 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL CERAMIC 28MMX-2.5MM 2026910 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 155 X 19 MM 2026920 CDM 278 RC facility both 14652 14652 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 155 X 19 MM 2026920 CDM 278 RC facility both 14652 14652 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 155 X 21 MM 2026922 CDM 278 RC facility both 14652 14652 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 155 X 21 MM 2026922 CDM 278 RC facility both 14652 14652 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 25 MM X +10MM 2026924 CDM 278 RC facility both 20450 20450 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 25 MM X +10MM 2026924 CDM 278 RC facility both 20450 20450 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE HEX 6.5 MMX 40 MM 2026925 CDM 278 RC facility both 545 545 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE HEX 6.5 MMX 40 MM 2026925 CDM 278 RC facility both 545 545 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION ADM X3 28MM X 52 X46F 2026926 CDM 278 RC facility both 7170 7170 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION ADM X3 28MM X 52 X46F 2026926 CDM 278 RC facility both 7170 7170 Gross Charge Type: NIHD_Hosp_Profee_Price ACTIVAPATCH® INTELLIDOSE™ 2.5 2026945 CDM facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price ACTIVAPATCH® INTELLIDOSE™ 2.5 2026945 CDM facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR INSERT JOURNEY 11 2026947 CDM 278 RC facility both 18560 18560 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR INSERT JOURNEY 11 2026947 CDM 278 RC facility both 18560 18560 Gross Charge Type: NIHD_Hosp_Profee_Price WAYNE PNEUMOTHORAX TRAY 29 CM 14 FR 2026950 CDM 272 RC facility both 694 694 Gross Charge Type: NIHD_Hosp_Profee_Price WAYNE PNEUMOTHORAX TRAY 29 CM 14 FR 2026950 CDM 272 RC facility both 694 694 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 05.0BDL 2026968 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 05.0BDL 2026968 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 05.5BDL 2026969 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 05.5BDL 2026969 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 06.0 BDL 2026970 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 06.0 BDL 2026970 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 07.0 BDL 2026971 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 07.0 BDL 2026971 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 07.5 BDL 2026972 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 07.5 BDL 2026972 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 08.0 BDL 2026973 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 08.0 BDL 2026973 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 08.5 BDL 2026974 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 08.5 BDL 2026974 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 09.0 BDL 2026975 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 09.0 BDL 2026975 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 09.5 BDL 2026976 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 09.5 BDL 2026976 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 10.0 BDL 2026978 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 10.0 BDL 2026978 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 10.5 BDL 2026979 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 10.5 BDL 2026979 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 11.0 BDL 2026980 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 11.0 BDL 2026980 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 12.0 BDL 2026981 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 12.0 BDL 2026981 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 13.0 BDL 2026982 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 13.0 BDL 2026982 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 13.5 BDL 2026983 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 13.5 BDL 2026983 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 14.0 BDL 2026984 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 14.0 BDL 2026984 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 14.5 BDL 2026985 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 14.5 BDL 2026985 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 15.0 BDL 2026986 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 15.0 BDL 2026986 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 15.5 BDL 2026987 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 15.5 BDL 2026987 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 16.0 BDL 2026988 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 16.0 BDL 2026988 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 16.5 BDL 2026989 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 16.5 BDL 2026989 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 17.0 BDL 2026990 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 17.0 BDL 2026990 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 19.0 BDL 2026991 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 19.0 BDL 2026991 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 18.0 BDL 2026992 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 18.0 BDL 2026992 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 19.5 BDL 2026993 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 19.5 BDL 2026993 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 20.0 BDL 2026994 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 20.0 BDL 2026994 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 20.5 BDL 2026995 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 20.5 BDL 2026995 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 21.0 BDL 2026996 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 21.0 BDL 2026996 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 21.5 BDL 2026997 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 21.5 BDL 2026997 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 22.0 BDL 2026998 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 22.0 BDL 2026998 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 22.5 BDL 2026999 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 22.5 BDL 2026999 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 23.0 BDL 2027000 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 23.0 BDL 2027000 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 23.5 BDL 2027001 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 23.5 BDL 2027001 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 24.0 BDL 2027002 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 24.0 BDL 2027002 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 24.5 BDL 2027004 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV 24.5 BDL 2027004 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV25.0 BDL 2027005 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV25.0 BDL 2027005 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV25.5 BDL 2027006 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV25.5 BDL 2027006 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV26.5 BDL 2027007 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI22UV26.5 BDL 2027007 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER L-FIT SZ 32X-2.5MM 2027030 CDM 278 RC facility both 8759 8759 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER L-FIT SZ 32X-2.5MM 2027030 CDM 278 RC facility both 8759 8759 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32MM 623-00-32D 2027031 CDM 278 RC facility both 7817 7817 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32MM 623-00-32D 2027031 CDM 278 RC facility both 7817 7817 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132 DEG SZ9 35X150MM ANGLE 2027033 CDM 278 RC facility both 22865 22865 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132 DEG SZ9 35X150MM ANGLE 2027033 CDM 278 RC facility both 22865 22865 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE COMPRESSION 6-HOLE 2027049 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE COMPRESSION 6-HOLE 2027049 CDM 278 RC facility both 1642 1642 Gross Charge Type: NIHD_Hosp_Profee_Price SAWBLADE PRECISION 25X1.27X105MM 2027079 CDM 272 RC facility both 1196 1196 Gross Charge Type: NIHD_Hosp_Profee_Price SAWBLADE PRECISION 25X1.27X105MM 2027079 CDM 272 RC facility both 1196 1196 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 40MM SZ MM 2027124 CDM 278 RC facility both 10284 10284 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 40MM SZ MM 2027124 CDM 278 RC facility both 10284 10284 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 40MM 12/14 TAP NECK +0 2027125 CDM 278 RC facility both 4767 4767 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 40MM 12/14 TAP NECK +0 2027125 CDM 278 RC facility both 4767 4767 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL RADIOLUCENT 3.2X148MM ZIMMER 2027130 CDM 272 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL RADIOLUCENT 3.2X148MM ZIMMER 2027130 CDM 272 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL RADIOLUCENT 4.0X148MM ZIMMER 2027131 CDM 272 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL RADIOLUCENT 4.0X148MM ZIMMER 2027131 CDM 272 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER PNEUMOTHORAX KIT 8 FR 2027135 CDM facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER PNEUMOTHORAX KIT 8 FR 2027135 CDM facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132 DEG SZ7 35X150MM ANGLE 2027142 CDM 278 RC facility both 22865 22865 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132 DEG SZ7 35X150MM ANGLE 2027142 CDM 278 RC facility both 22865 22865 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 32MM 18-3200 2027143 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 32MM 18-3200 2027143 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price STEM SHOULDER MINI HUMERAL 9MM BIOMET 2027181 CDM 278 RC facility both 21228 21228 Gross Charge Type: NIHD_Hosp_Profee_Price STEM SHOULDER MINI HUMERAL 9MM BIOMET 2027181 CDM 278 RC facility both 21228 21228 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE MINI FT LISFRANC 4.5X14MM 2027184 CDM 278 RC facility both 2915 2915 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE MINI FT LISFRANC 4.5X14MM 2027184 CDM 278 RC facility both 2915 2915 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE MINI REPAIR IMPLANT CAN 2027185 CDM 278 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE MINI REPAIR IMPLANT CAN 2027185 CDM 278 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price EVICEL FIBRIN SEALANT LAP FLEXIBLE TIP 2027211 CDM 272 RC facility both 340 340 Gross Charge Type: NIHD_Hosp_Profee_Price EVICEL FIBRIN SEALANT LAP FLEXIBLE TIP 2027211 CDM 272 RC facility both 340 340 Gross Charge Type: NIHD_Hosp_Profee_Price EVICEL FIBRIN HUMAN SEALANT SYRINGE 2027212 CDM 272 RC facility both 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price EVICEL FIBRIN HUMAN SEALANT SYRINGE 2027212 CDM 272 RC facility both 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X55MM 2027214 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X55MM 2027214 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X60MM 2027215 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X60MM 2027215 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X70MM 2027216 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X70MM 2027216 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X85MM 2027217 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X85MM 2027217 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X40X90MM 2027218 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X40X90MM 2027218 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE LIGAMENT AUGMENTATION REPAIR KIT 2027226 CDM 278 RC facility both 5121 5121 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE LIGAMENT AUGMENTATION REPAIR KIT 2027226 CDM 278 RC facility both 5121 5121 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO WIRE LOOP 2027227 CDM 272 RC facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO WIRE LOOP 2027227 CDM 272 RC facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL MICRO-ACUTRAK 2 2027234 CDM 272 RC facility both 1344 1344 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL MICRO-ACUTRAK 2 2027234 CDM 272 RC facility both 1344 1344 Gross Charge Type: NIHD_Hosp_Profee_Price FASTFIX STRUT LONG 2027252 CDM 272 RC facility both 4848 4848 Gross Charge Type: NIHD_Hosp_Profee_Price FASTFIX STRUT LONG 2027252 CDM 272 RC facility both 4848 4848 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 7MM 2027266 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 7MM 2027266 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 7.5MM 2027267 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 7.5MM 2027267 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SCORPION KNEE 2027325 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SCORPION KNEE 2027325 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR BLUE /C-H 14MM 005976-40-14 2027331 CDM 278 RC facility both 7406 7406 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR BLUE /C-H 14MM 005976-40-14 2027331 CDM 278 RC facility both 7406 7406 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT AFLEX301 40X70X3.0 2027367 CDM 278 RC facility both 11835 11835 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT AFLEX301 40X70X3.0 2027367 CDM 278 RC facility both 11835 11835 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX TAP 3.5X70MM 2027390 CDM 278 RC facility both 514 514 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX TAP 3.5X70MM 2027390 CDM 278 RC facility both 514 514 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 12X30MM 2027431 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 12X30MM 2027431 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR SWVLOC 4.75X19.1 W/TAPE 2027441 CDM 272 RC facility both 1410 1410 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR SWVLOC 4.75X19.1 W/TAPE 2027441 CDM 272 RC facility both 1410 1410 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32-E 2027445 CDM 278 RC facility both 7817 7817 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32-E 2027445 CDM 278 RC facility both 7817 7817 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP 127 NECK ANGLE 8X30MM C-TPR 2027446 CDM 278 RC facility both 22865 22865 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP 127 NECK ANGLE 8X30MM C-TPR 2027446 CDM 278 RC facility both 22865 22865 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 60 MM F 2027457 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 60 MM F 2027457 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT RESTORATION SIZE 28/52 SIZE 46F 2027459 CDM 278 RC facility both 7969 7969 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT RESTORATION SIZE 28/52 SIZE 46F 2027459 CDM 278 RC facility both 7969 7969 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 28MM+5 2027461 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 28MM+5 2027461 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price LINER CEMENTLESS 46MM F 2027462 CDM 278 RC facility both 10117 10117 Gross Charge Type: NIHD_Hosp_Profee_Price LINER CEMENTLESS 46MM F 2027462 CDM 278 RC facility both 10117 10117 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX G- RIGHT 2027463 CDM 278 RC facility both 23747 23747 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX G- RIGHT 2027463 CDM 278 RC facility both 23747 23747 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X20X100MM 2027500 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X20X100MM 2027500 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X20X115MM 2027501 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X20X115MM 2027501 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X20X120MM 2027502 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X20X120MM 2027502 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X40X110MM 2027503 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X40X110MM 2027503 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SPEED BRIDGE SWIVELOCK 4.75X19.1MM 2027509 CDM 278 RC facility both 5218 5218 Gross Charge Type: NIHD_Hosp_Profee_Price SPEED BRIDGE SWIVELOCK 4.75X19.1MM 2027509 CDM 278 RC facility both 5218 5218 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 1.4X1.5MM FOOT 2027525 CDM 272 RC facility both 440 440 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 1.4X1.5MM FOOT 2027525 CDM 272 RC facility both 440 440 Gross Charge Type: NIHD_Hosp_Profee_Price CUFF AND COLLAR SLING 2027535 CDM 271 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CUFF AND COLLAR SLING 2027535 CDM 271 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price URETERAL CATHETER CONNECTOR ( DR DAVIS) 2027555 CDM 272 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price URETERAL CATHETER CONNECTOR ( DR DAVIS) 2027555 CDM 272 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 8.0X25X60MM 2027557 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 8.0X25X60MM 2027557 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 8.0X25X75MM 2027558 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 8.0X25X75MM 2027558 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 8.0X25X95MM 2027559 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 8.0X25X95MM 2027559 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X20X105MM 2027575 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 6.5X20X105MM 2027575 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X110MM 2027576 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X110MM 2027576 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X80MM 2027578 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X80MM 2027578 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X45MM 2027579 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X45MM 2027579 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X50MM 2027580 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X50MM 2027580 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X65MM 2027581 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X65MM 2027581 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X75MM 2027583 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X75MM 2027583 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 8.0X25X85MM 2027584 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREAD STAINLESS 8.0X25X85MM 2027584 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X40MM 2027596 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X40MM 2027596 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X95MM 2027598 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X20X95MM 2027598 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X40X95MM 2027611 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X40X95MM 2027611 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X40X100MM 2027612 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 6.5X40X100MM 2027612 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price ROD SEMI CIRCLE CURVED HOFFMAN 3 11X100M 2027634 CDM 272 RC facility both 1091 1091 Gross Charge Type: NIHD_Hosp_Profee_Price ROD SEMI CIRCLE CURVED HOFFMAN 3 11X100M 2027634 CDM 272 RC facility both 1091 1091 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE THREADED 2.0X1.5MM STYKER 2027635 CDM 272 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE THREADED 2.0X1.5MM STYKER 2027635 CDM 272 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT CANNULATED 3.5MM AO 2027637 CDM 272 RC facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT CANNULATED 3.5MM AO 2027637 CDM 272 RC facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0X1.5 MM AO COUPLING 2027640 CDM 272 RC facility both 709 709 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0X1.5 MM AO COUPLING 2027640 CDM 272 RC facility both 709 709 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 32X8MM 2027698 CDM 278 RC facility both 3832 3832 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 32X8MM 2027698 CDM 278 RC facility both 3832 3832 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 3X30X102MM 2027699 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 3X30X102MM 2027699 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE 125 DEG ACC 11 2X30X99MM 2027701 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE 125 DEG ACC 11 2X30X99MM 2027701 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 32X +0MM 2027703 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 32X +0MM 2027703 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE RESECT LOOP 24 FR 0.2 WIRE 2027718 CDM 272 RC facility both 1372 1372 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE RESECT LOOP 24 FR 0.2 WIRE 2027718 CDM 272 RC facility both 1372 1372 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE RESECT LOOP 24 FR 0.2 2027719 CDM 272 RC facility both 1569 1569 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE RESECT LOOP 24 FR 0.2 2027719 CDM 272 RC facility both 1569 1569 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 30CM 2027727 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 30CM 2027727 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 28CM 2027728 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 28CM 2027728 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 26CM 2027729 CDM 278 RC facility both 401 401 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 26CM 2027729 CDM 278 RC facility both 401 401 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 24CM 2027730 CDM 278 RC facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 24CM 2027730 CDM 278 RC facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 22CM 2027731 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 6FR X 22CM 2027731 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 4.5FR X 30CM 2027732 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 4.5FR X 30CM 2027732 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 4.5FR X 28CM 2027733 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 4.5FR X 28CM 2027733 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 4.5FR X 26CM 2027734 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 4.5FR X 26CM 2027734 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 4.5FR X 24CM 2027735 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price STENT URETERAL SOFT CURL 4.5FR X 24CM 2027735 CDM 278 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE ANGLETIP HYBRID 0.0035 2027737 CDM 272 RC facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE ANGLETIP HYBRID 0.0035 2027737 CDM 272 RC facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE HYBRID 0.0035 2027738 CDM 272 RC facility both 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE HYBRID 0.0035 2027738 CDM 272 RC facility both 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DUAL LUMEN 10 FR 2027740 CDM 272 RC facility both 603 603 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DUAL LUMEN 10 FR 2027740 CDM 272 RC facility both 603 603 Gross Charge Type: NIHD_Hosp_Profee_Price GLIDEWIRE ANG TIP REG BODY 3 CM 2027741 CDM 272 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price GLIDEWIRE ANG TIP REG BODY 3 CM 2027741 CDM 272 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price GLIDEWIRE 0.035 ANG TIP STIFF BODY 3 CM 2027742 CDM 272 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price GLIDEWIRE 0.035 ANG TIP STIFF BODY 3 CM 2027742 CDM 272 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price GLIDEWIRE 0.035 STRTIP REG BODY 3 CM 2027743 CDM 272 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price GLIDEWIRE 0.035 STRTIP REG BODY 3 CM 2027743 CDM 272 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price UROPASS AS 11/13FR X 46 CM 2027745 CDM 278 RC facility both 2003 2003 Gross Charge Type: NIHD_Hosp_Profee_Price UROPASS AS 11/13FR X 46 CM 2027745 CDM 278 RC facility both 2003 2003 Gross Charge Type: NIHD_Hosp_Profee_Price UROPASS AS 11/13FR X 24 CM 2027747 CDM 272 RC facility both 2003 2003 Gross Charge Type: NIHD_Hosp_Profee_Price UROPASS AS 11/13FR X 24 CM 2027747 CDM 272 RC facility both 2003 2003 Gross Charge Type: NIHD_Hosp_Profee_Price UROPASS AS SHEATH 11/12FRX38 CM 2027750 CDM 278 RC facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price UROPASS AS SHEATH 11/12FRX38 CM 2027750 CDM 278 RC facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 2-0 GS-22 6 INCH A ROBINSON 2027752 CDM 272 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 2-0 GS-22 6 INCH A ROBINSON 2027752 CDM 272 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER URETERAL 5 FR OPEN ENDED 2027757 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER URETERAL 5 FR OPEN ENDED 2027757 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price PERK-N-CIRCLE 10 FR UROLOGY 2027758 CDM 272 RC facility both 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price PERK-N-CIRCLE 10 FR UROLOGY 2027758 CDM 272 RC facility both 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price PERK-N-CIRCLE 12 FR UROLOGY 2027759 CDM 272 RC facility both 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price PERK-N-CIRCLE 12 FR UROLOGY 2027759 CDM 272 RC facility both 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS PCB00 19.5 2027762 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS PCB00 19.5 2027762 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS PCB00 20.0 2027763 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS PCB00 20.0 2027763 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS PCB00 20.5 2027765 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS PCB00 20.5 2027765 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS PCB00 15.5 2027766 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS PCB00 15.5 2027766 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price BIOZORB MARKER 2CMX 2CM 2027782 CDM 278 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price BIOZORB MARKER 2CMX 2CM 2027782 CDM 278 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price BIOZORB MARKER 2CMX 3CM 2027783 CDM 278 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price BIOZORB MARKER 2CMX 3CM 2027783 CDM 278 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price BIOZORB 3CMX3CM 2027785 CDM 278 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price BIOZORB 3CMX3CM 2027785 CDM 278 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price BIOZORB 3CMX4CM 2027786 CDM 278 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price BIOZORB 3CMX4CM 2027786 CDM 278 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DILATION FILIFORM COUDE TIP 5FR 2027790 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DILATION FILIFORM COUDE TIP 5FR 2027790 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DILATION FILIFORM COUDE TIP 6FR 2027791 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DILATION FILIFORM COUDE TIP 6FR 2027791 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM COUDE TIP 4FR 12.5 2027792 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM COUDE TIP 4FR 12.5 2027792 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM COUDE TIP 5FR 12.5 2027793 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM COUDE TIP 5FR 12.5 2027793 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM COUDE TIP 6FR 12.5 2027794 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM COUDE TIP 6FR 12.5 2027794 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM SPIRALTIP 4FR 18IN 2027795 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM SPIRALTIP 4FR 18IN 2027795 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM SPIRAL TIP 4FR 18 2027798 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM SPIRAL TIP 4FR 18 2027798 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM SPIRAL TIP 6FR 18 2027799 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM SPIRAL TIP 6FR 18 2027799 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRAIGH TIP 4FR 18 2027800 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRAIGH TIP 4FR 18 2027800 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRAIGH TIP 5FR 18 2027801 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRAIGH TIP 5FR 18 2027801 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRT TIP 6FR 18IN 2027802 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRT TIP 6FR 18IN 2027802 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRT TIP 5FR 12.5 2027804 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRT TIP 5FR 12.5 2027804 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price MINI JOINT DISTRACTOR TRACTI SCREW 16MM 2027819 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price MINI JOINT DISTRACTOR TRACTI SCREW 16MM 2027819 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price MINI JOINT DISTRACTOR TRACT SCREW 20MM 2027820 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price MINI JOINT DISTRACTOR TRACT SCREW 20MM 2027820 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price LITHOVUE SINGLE USE DIG FLEX URETEROSCOP 2027822 CDM 272 RC facility both 4498 4498 Gross Charge Type: NIHD_Hosp_Profee_Price LITHOVUE SINGLE USE DIG FLEX URETEROSCOP 2027822 CDM 272 RC facility both 4498 4498 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 150 UM HOLM RD TIP SMA905 2027826 CDM 272 RC facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 150 UM HOLM RD TIP SMA905 2027826 CDM 272 RC facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 200 UM HOLM RD TIP SMA905 2027827 CDM 272 RC facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 200 UM HOLM RD TIP SMA905 2027827 CDM 272 RC facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 365 UM HOLM RD TIP SMA905 2027829 CDM 272 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 365 UM HOLM RD TIP SMA905 2027829 CDM 272 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 500 UM HOLM RD TIP SMA905 2027830 CDM 272 RC facility both 591 591 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 500 UM HOLM RD TIP SMA905 2027830 CDM 272 RC facility both 591 591 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 940 UM HOLM RD TIP SMA905 2027831 CDM 272 RC facility both 1089 1089 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 940 UM HOLM RD TIP SMA905 2027831 CDM 272 RC facility both 1089 1089 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE SAL LARGE PLASMALOOP BIP 12&30 2027832 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE SAL LARGE PLASMALOOP BIP 12&30 2027832 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE SAL MED PLASMA LOOP BIP12&30 2027834 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE SAL MED PLASMA LOOP BIP12&30 2027834 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price RING PESSARY W/ SUPPORT RING SZ 0 2027840 CDM facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price RING PESSARY W/ SUPPORT RING SZ 0 2027840 CDM facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2 X 13MM 2027843 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2 X 13MM 2027843 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price HEYMEN FOLLOWER KIT 10FR-24FR SET COUDE 2027845 CDM 272 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price HEYMEN FOLLOWER KIT 10FR-24FR SET COUDE 2027845 CDM 272 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price K WIRE 2.4 MM ARTHREX MINI DISECT TRAY 2027850 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price K WIRE 2.4 MM ARTHREX MINI DISECT TRAY 2027850 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 145 DEG X 2HL SHORT BARREL 2027856 CDM 278 RC facility both 2973 2973 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 145 DEG X 2HL SHORT BARREL 2027856 CDM 278 RC facility both 2973 2973 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS WOVEN 12FR URETHRAL CATH 2027861 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS WOVEN 12FR URETHRAL CATH 2027861 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 8FR URET CATH 2027862 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 8FR URET CATH 2027862 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 10FR URETHERAL 2027863 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 10FR URETHERAL 2027863 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS WOVEN PHIL 20FR URETHRAL CATH 2027864 CDM 272 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS WOVEN PHIL 20FR URETHRAL CATH 2027864 CDM 272 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS WOVEN 22FR URETHRAL CATH 2027865 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS WOVEN 22FR URETHRAL CATH 2027865 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price CATH DILATOR WALTHER FEMALE ALE 34FR 2027887 CDM 272 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price CATH DILATOR WALTHER FEMALE ALE 34FR 2027887 CDM 272 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price SUPRAPUBIC FOLEY TRAY 2027896 CDM 278 RC facility both 1750 1750 Gross Charge Type: NIHD_Hosp_Profee_Price SUPRAPUBIC FOLEY TRAY 2027896 CDM 278 RC facility both 1750 1750 Gross Charge Type: NIHD_Hosp_Profee_Price SUPRAPUBIC FOLEY TRAY 143112 2027898 CDM 272 RC facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price SUPRAPUBIC FOLEY TRAY 143112 2027898 CDM 272 RC facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD HUMERAL MOD VERSA-DIAL 46X21X50 2027904 CDM 278 RC facility both 9325 9325 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD HUMERAL MOD VERSA-DIAL 46X21X50 2027904 CDM 278 RC facility both 9325 9325 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5MMX25MM CENTRAL 2027905 CDM 278 RC facility both 711 711 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5MMX25MM CENTRAL 2027905 CDM 278 RC facility both 711 711 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWER WOVEN URETHRAL BOUGIE 8FR 2027928 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWER WOVEN URETHRAL BOUGIE 8FR 2027928 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM 12/14 TAPER SZ 2- STDDEPUY 2027943 CDM 278 RC facility both 27749 27749 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM 12/14 TAPER SZ 2- STDDEPUY 2027943 CDM 278 RC facility both 27749 27749 Gross Charge Type: NIHD_Hosp_Profee_Price GLYCINE 3000 BAGS 2027945 CDM 272 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price GLYCINE 3000 BAGS 2027945 CDM 272 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 8.0X25X100MM 2027951 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 8.0X25X100MM 2027951 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 8.0X25X105MM 2027953 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 8.0X25X105MM 2027953 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 8MM LENGTH" 2027954 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 8MM LENGTH" 2027954 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 9MM LENGTH" 2027955 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 9MM LENGTH" 2027955 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 10MM LENGTH" 2027956 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 10MM LENGTH" 2027956 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 11MM LENGTH" 2027957 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 11MM LENGTH" 2027957 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 12MM LENGTH" 2027958 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 12MM LENGTH" 2027958 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 13MM LENGTH" 2027959 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 13MM LENGTH" 2027959 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 14MM LENGTH" 2027960 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 14MM LENGTH" 2027960 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 16MM LENGTH" 2027961 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 16MM LENGTH" 2027961 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 18MM LENGTH" 2027962 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 18MM LENGTH" 2027962 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 20MM LENGTH" 2027963 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 20MM LENGTH" 2027963 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 22MM LENGTH" 2027964 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 22MM LENGTH" 2027964 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 24MM LENGTH" 2027965 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 24MM LENGTH" 2027965 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 26MM LENGTH" 2027966 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 26MM LENGTH" 2027966 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 28MM LENGTH" 2027967 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 28MM LENGTH" 2027967 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 30MM LENGTH" 2027968 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 2.5 MICRO, 30MM LENGTH" 2027968 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 12MM LENGTH" 2027969 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 12MM LENGTH" 2027969 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 14MM LENGTH" 2027970 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 14MM LENGTH" 2027970 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW COMPR-FT 3.5 MINI 16MM LENGTH 2027971 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW COMPR-FT 3.5 MINI 16MM LENGTH 2027971 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 18MM LENGTH" 2027972 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 18MM LENGTH" 2027972 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW COMPR-FT 3.5 MINI 20MM LENGTH 2027973 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW COMPR-FT 3.5 MINI 20MM LENGTH 2027973 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 22MM LENGTH" 2027974 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 22MM LENGTH" 2027974 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 24MM LENGTH" 2027975 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 24MM LENGTH" 2027975 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 26MM LENGTH" 2027976 CDM 278 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 26MM LENGTH" 2027976 CDM 278 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW COMPR-FT 3.5 MINI 28MM LENGTH 2027977 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW COMPR-FT 3.5 MINI 28MM LENGTH 2027977 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 30MM LENGTH" 2027978 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 30MM LENGTH" 2027978 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 32MM LENGTH" 2027979 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 32MM LENGTH" 2027979 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 34MM LENGTH" 2027980 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "SCREW COMPR-FT 3.5 MINI, 34MM LENGTH" 2027980 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0MM COMP FT CALIBRATED 2027981 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0MM COMP FT CALIBRATED 2027981 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.7MM COMP FT CALIBRATED 2027982 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.7MM COMP FT CALIBRATED 2027982 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE TROCAR TIP 0.86MM 2027983 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE TROCAR TIP 0.86MM 2027983 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE TROCAR THREADED TIP 0.86MM 2027984 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE TROCAR THREADED TIP 0.86MM 2027984 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE TROCAR TIP 0.45 2027985 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE TROCAR TIP 0.45 2027985 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE TROCAR THREADED TIP 0.45 2027986 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE TROCAR THREADED TIP 0.45 2027986 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL PROFILE MICR COMP FT 2027987 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL PROFILE MICR COMP FT 2027987 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL PROFILE MINI COMP FT 2027988 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL PROFILE MINI COMP FT 2027988 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT COMP FT 3.2 MM CALIBRATED 2027989 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT COMP FT 3.2 MM CALIBRATED 2027989 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 16MM LENGTH COMP FT 2027990 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 16MM LENGTH COMP FT 2027990 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 18MM LENGTH COMP FT 2027991 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 18MM LENGTH COMP FT 2027991 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 20MM LENGTH COMP FT 2027992 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 20MM LENGTH COMP FT 2027992 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 22MM LENGTH COMP FT 2027993 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 22MM LENGTH COMP FT 2027993 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 24MM LENGTH COMP FT 2027994 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 24MM LENGTH COMP FT 2027994 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 26MM LENGTH COMP FT 2027995 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 26MM LENGTH COMP FT 2027995 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 28MM LENGTH COMP FT 2027996 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 28MM LENGTH COMP FT 2027996 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 30MM LENGTH COMP FT 2027997 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 30MM LENGTH COMP FT 2027997 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 32MM LENGTH COMP FT 2027998 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 32MM LENGTH COMP FT 2027998 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 36MM LENGTH COMP FT 2027999 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 36MM LENGTH COMP FT 2027999 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 38MM LENGTH COMP FT 2028000 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 38MM LENGTH COMP FT 2028000 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 40HMM LENGTH COMP FT 2028001 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 40HMM LENGTH COMP FT 2028001 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 42MM LENGTH COMP FT 2028002 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 42MM LENGTH COMP FT 2028002 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 44MM LENGTH COMP FT 2028003 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 44MM LENGTH COMP FT 2028003 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 46MM LENGTH COMP FT 2028004 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 46MM LENGTH COMP FT 2028004 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 48MM LENGTH COMP FT 2028005 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 48MM LENGTH COMP FT 2028005 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 50MM LENGTH COMP FT 2028006 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 4.0 STD 50MM LENGTH COMP FT 2028006 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE NECK ACCOLADE 11 4X35X140 2028007 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE NECK ACCOLADE 11 4X35X140 2028007 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT BONE REFOBACIN WITH GENT 2028008 CDM 278 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT BONE REFOBACIN WITH GENT 2028008 CDM 278 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price IOL SYMFONY ZXR0017.5 2028015 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL SYMFONY ZXR0017.5 2028015 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price EPIFIX 2CM X 2 CM SHEET 2028021 CDM 636 RC facility both 798 798 Gross Charge Type: NIHD_Hosp_Profee_Price EPIFIX 2CM X 2 CM SHEET 2028021 CDM 636 RC facility both 798 798 Gross Charge Type: NIHD_Hosp_Profee_Price EPIFIX 2CM X 3CM SHEET 2028022 CDM 636 RC facility both 572 572 Gross Charge Type: NIHD_Hosp_Profee_Price EPIFIX 2CM X 3CM SHEET 2028022 CDM 636 RC facility both 572 572 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZLB00 21.5 1 PIECE 3.25 2028027 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZLB00 21.5 1 PIECE 3.25 2028027 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price BACTISURE WOUND LAVAGE 2028029 CDM 272 RC facility both 2984 2984 Gross Charge Type: NIHD_Hosp_Profee_Price BACTISURE WOUND LAVAGE 2028029 CDM 272 RC facility both 2984 2984 Gross Charge Type: NIHD_Hosp_Profee_Price HIP HEAD CEMENT MOLD SIS 431183 2028032 CDM 278 RC facility both 5487 5487 Gross Charge Type: NIHD_Hosp_Profee_Price HIP HEAD CEMENT MOLD SIS 431183 2028032 CDM 278 RC facility both 5487 5487 Gross Charge Type: NIHD_Hosp_Profee_Price HIP MOLD STEM E REINF 9X125 2028033 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price HIP MOLD STEM E REINF 9X125 2028033 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X50MM 2028034 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X50MM 2028034 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price AMNIOFILL 500MG 2028040 CDM 278 RC facility both 3448 3448 Gross Charge Type: NIHD_Hosp_Profee_Price AMNIOFILL 500MG 2028040 CDM 278 RC facility both 3448 3448 Gross Charge Type: NIHD_Hosp_Profee_Price AMNIOFILL 1000MG 2028041 CDM 278 RC facility both 6747 6747 Gross Charge Type: NIHD_Hosp_Profee_Price AMNIOFILL 1000MG 2028041 CDM 278 RC facility both 6747 6747 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT BONE REFOBACIN PLAIN 2028045 CDM 278 RC facility both 570 570 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT BONE REFOBACIN PLAIN 2028045 CDM 278 RC facility both 570 570 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM SMALL HYBRID GLENOID BASE 113952 2028046 CDM 278 RC facility both 7976 7976 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM SMALL HYBRID GLENOID BASE 113952 2028046 CDM 278 RC facility both 7976 7976 Gross Charge Type: NIHD_Hosp_Profee_Price HYBRID GLENOID POST 2028047 CDM 278 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price HYBRID GLENOID POST 2028047 CDM 278 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE EXPLANT TRUNCATED 56MM 2028049 CDM 272 RC facility both 3538 3538 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE EXPLANT TRUNCATED 56MM 2028049 CDM 272 RC facility both 3538 3538 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE EXPLANT FULL 56MM ZIMMER 2028050 CDM 272 RC facility both 3538 3538 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE EXPLANT FULL 56MM ZIMMER 2028050 CDM 272 RC facility both 3538 3538 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZLB00 22.0 PIECE 3.25 2028052 CDM 278 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZLB00 22.0 PIECE 3.25 2028052 CDM 278 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX D RIGHT 00575001402 2028063 CDM 278 RC facility both 23747 23747 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX D RIGHT 00575001402 2028063 CDM 278 RC facility both 23747 23747 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING XX SMALL 2028080 CDM 271 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING XX SMALL 2028080 CDM 271 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING X SMALL 2028081 CDM 271 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING X SMALL 2028081 CDM 271 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 32X -4MM 2028083 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 32X -4MM 2028083 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE#4 35X105MM 2028084 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE#4 35X105MM 2028084 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR 3.5 TORPEDO SMALL JOINT AR-7350TD 2028101 CDM 272 RC facility both 436 436 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR 3.5 TORPEDO SMALL JOINT AR-7350TD 2028101 CDM 272 RC facility both 436 436 Gross Charge Type: NIHD_Hosp_Profee_Price OSTEOCHONDRAL FLAP REPAIR SGLE SHOT INST 2028102 CDM 272 RC facility both 880 880 Gross Charge Type: NIHD_Hosp_Profee_Price OSTEOCHONDRAL FLAP REPAIR SGLE SHOT INST 2028102 CDM 272 RC facility both 880 880 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHREX CHONDRAL DART 1.3X18MM 2028104 CDM 278 RC facility both 1815 1815 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHREX CHONDRAL DART 1.3X18MM 2028104 CDM 278 RC facility both 1815 1815 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR CORKSCREW AR-1927BCT 2028105 CDM 272 RC facility both 1065 1065 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR CORKSCREW AR-1927BCT 2028105 CDM 272 RC facility both 1065 1065 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 6 35X111MM 2028106 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 6 35X111MM 2028106 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price 5X180 APEX S/D HALF PIN 50 THR 5018-8-180 2028112 CDM 278 RC facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price 5X180 APEX S/D HALF PIN 50 THR 5018-8-180 2028112 CDM 278 RC facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price SINGLE ACTION PUMP SYSTEM 2028116 CDM 272 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price SINGLE ACTION PUMP SYSTEM 2028116 CDM 272 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE GLENOSPHERE 36MM +3 CURVED/STAND 2028134 CDM 278 RC facility both 7646 7646 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE GLENOSPHERE 36MM +3 CURVED/STAND 2028134 CDM 278 RC facility both 7646 7646 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 21.0 3 PIECE 2028140 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 21.0 3 PIECE 2028140 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 14FR URET CATH 2028142 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 14FR URET CATH 2028142 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 16FR URET CATH 2028143 CDM 272 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 16FR URET CATH 2028143 CDM 272 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 18FR URET CATH 2028144 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price FOLLOWERS PHILLIPS WOVEN 18FR URET CATH 2028144 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE 127 DEG ACC 11 6X35X111M 2028145 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE 127 DEG ACC 11 6X35X111M 2028145 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price PROSTATE BIOPSY CORE NEEDLE 14X10 2028146 CDM 272 RC facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price PROSTATE BIOPSY CORE NEEDLE 14X10 2028146 CDM 272 RC facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOCK 90 4.0 - P14 12 INCHES LONG 2028173 CDM 272 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOCK 90 4.0 - P14 12 INCHES LONG 2028173 CDM 272 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOCK 90 4.0 - P14 18 INCHES LONG 2028174 CDM 272 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOCK 90 4.0 - P14 18 INCHES LONG 2028174 CDM 272 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOCK 90 4.0 - P14 23 INCHES LONG 2028175 CDM 272 RC facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOCK 90 4.0 - P14 23 INCHES LONG 2028175 CDM 272 RC facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price VERSAONE FASCIAL CLOSURE SYS OPTICAL 2028176 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price VERSAONE FASCIAL CLOSURE SYS OPTICAL 2028176 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE PRECISE EXACT DISSECTOR 2028178 CDM 272 RC facility both 1487 1487 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE PRECISE EXACT DISSECTOR 2028178 CDM 272 RC facility both 1487 1487 Gross Charge Type: NIHD_Hosp_Profee_Price CONTINUUM CONSTRAINED LINER 28MM X 50HH 2028180 CDM 278 RC facility both 18919 18919 Gross Charge Type: NIHD_Hosp_Profee_Price CONTINUUM CONSTRAINED LINER 28MM X 50HH 2028180 CDM 278 RC facility both 18919 18919 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 12/14 COCR 28MM+0 2028181 CDM 278 RC facility both 4018 4018 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 12/14 COCR 28MM+0 2028181 CDM 278 RC facility both 4018 4018 Gross Charge Type: NIHD_Hosp_Profee_Price ALLOSYNC DBM GEL 5CC ARTHREX 2028216 CDM 278 RC facility both 3428 3428 Gross Charge Type: NIHD_Hosp_Profee_Price ALLOSYNC DBM GEL 5CC ARTHREX 2028216 CDM 278 RC facility both 3428 3428 Gross Charge Type: NIHD_Hosp_Profee_Price RETRIEVEL BAG 5MM LAP INZII UNIVERSAL 2028221 CDM 272 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price RETRIEVEL BAG 5MM LAP INZII UNIVERSAL 2028221 CDM 272 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price GELPOINT PATH MINI PLATFORM 2028222 CDM 272 RC facility both 2025 2025 Gross Charge Type: NIHD_Hosp_Profee_Price GELPOINT PATH MINI PLATFORM 2028222 CDM 272 RC facility both 2025 2025 Gross Charge Type: NIHD_Hosp_Profee_Price GELPOINT PATH PLATFORM WITH ISB 2028223 CDM 272 RC facility both 2625 2625 Gross Charge Type: NIHD_Hosp_Profee_Price GELPOINT PATH PLATFORM WITH ISB 2028223 CDM 272 RC facility both 2625 2625 Gross Charge Type: NIHD_Hosp_Profee_Price ALEXIS O WOUND PROTECTOR MEDIUM RIGID 2028224 CDM 272 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price ALEXIS O WOUND PROTECTOR MEDIUM RIGID 2028224 CDM 272 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 62MM G 2028230 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 62MM G 2028230 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36MM 2028231 CDM 278 RC facility both 7681 7681 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36MM 2028231 CDM 278 RC facility both 7681 7681 Gross Charge Type: NIHD_Hosp_Profee_Price ALEXIS LAPAROSCOPIC SYSTEM WITH KI TROCA 2028234 CDM 272 RC facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price ALEXIS LAPAROSCOPIC SYSTEM WITH KI TROCA 2028234 CDM 272 RC facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 20FR 2028237 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_RHC_Price DRAIN LATEX MALECOT 4WING 20FR 2028237 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_Clinic_Price DRAIN LATEX MALECOT 4WING 20FR 2028237 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 20FR 2028237 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 22FR 2028238 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_RHC_Price DRAIN LATEX MALECOT 4WING 22FR 2028238 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_Clinic_Price DRAIN LATEX MALECOT 4WING 22FR 2028238 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 22FR 2028238 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 24FR 2028239 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_RHC_Price DRAIN LATEX MALECOT 4WING 24FR 2028239 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_Clinic_Price DRAIN LATEX MALECOT 4WING 24FR 2028239 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 24FR 2028239 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 32MM DIAMETER 5972-65-32 2028243 CDM 278 RC facility both 3959 3959 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 32MM DIAMETER 5972-65-32 2028243 CDM 278 RC facility both 3959 3959 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.5 CORTICAL OPENER 2028244 CDM 278 RC facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.5 CORTICAL OPENER 2028244 CDM 278 RC facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT LEFT MEDIAL FEMORAL CONDYLE 2028246 CDM 278 RC facility both 34990 34990 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT LEFT MEDIAL FEMORAL CONDYLE 2028246 CDM 278 RC facility both 34990 34990 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT ACHILLES PRE SHAPED 10MMX26LENGTH 2028251 CDM 278 RC facility both 8118 8118 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT ACHILLES PRE SHAPED 10MMX26LENGTH 2028251 CDM 278 RC facility both 8118 8118 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2 X 16MM 2028258 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2 X 16MM 2028258 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERSTICK #2 2028262 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERSTICK #2 2028262 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price TIGERSTICK 2028263 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price TIGERSTICK 2028263 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ABS BUTTON ROUND CONCAVE 2028264 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ABS BUTTON ROUND CONCAVE 2028264 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price STEM MINI HUMERAL BIOMET 13MMX83MM LONG 2028273 CDM 278 RC facility both 21228 21228 Gross Charge Type: NIHD_Hosp_Profee_Price STEM MINI HUMERAL BIOMET 13MMX83MM LONG 2028273 CDM 278 RC facility both 21228 21228 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X16MM 2028274 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X16MM 2028274 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 8.0X25X110MM 2028279 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 8.0X25X110MM 2028279 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 8.0X25X90MM 2028280 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 8.0X25X90MM 2028280 CDM 278 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERAL NAIL T2 7 X 210MM 2028286 CDM 278 RC facility both 2758 2758 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERAL NAIL T2 7 X 210MM 2028286 CDM 278 RC facility both 2758 2758 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL CERAMIC V40 SZ 28MM -4MM 2028288 CDM 278 RC facility both 8594 8594 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL CERAMIC V40 SZ 28MM -4MM 2028288 CDM 278 RC facility both 8594 8594 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE SMOOTH T2 HUMERUS SET 2028294 CDM 272 RC facility both 333 333 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE SMOOTH T2 HUMERUS SET 2028294 CDM 272 RC facility both 333 333 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE BALL TIP 02.5X800 T2 HUMERAL 2028296 CDM 272 RC facility both 727 727 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE BALL TIP 02.5X800 T2 HUMERAL 2028296 CDM 272 RC facility both 727 727 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 03.5X230MM 2028297 CDM 272 RC facility both 734 734 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 03.5X230MM 2028297 CDM 272 RC facility both 734 734 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 03.5X130MM 2028298 CDM 272 RC facility both 734 734 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 03.5X130MM 2028298 CDM 272 RC facility both 734 734 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW FULLY THREADED 04X45MM 2028299 CDM 278 RC facility both 354 354 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW FULLY THREADED 04X45MM 2028299 CDM 278 RC facility both 354 354 Gross Charge Type: NIHD_Hosp_Profee_Price TUBE TEFLON T2- HUMERAL NAIL 2028300 CDM 272 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price TUBE TEFLON T2- HUMERAL NAIL 2028300 CDM 272 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price ENDCAP 0.10-+2 T2- HUMERAL NAIL 2028302 CDM 278 RC facility both 711 711 Gross Charge Type: NIHD_Hosp_Profee_Price ENDCAP 0.10-+2 T2- HUMERAL NAIL 2028302 CDM 278 RC facility both 711 711 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW FULLY THREAD 04X30MM 2028305 CDM 278 RC facility both 738 738 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW FULLY THREAD 04X30MM 2028305 CDM 278 RC facility both 738 738 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CARDIFF TISSUE 2028307 CDM 278 RC facility both 25486 25486 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CARDIFF TISSUE 2028307 CDM 278 RC facility both 25486 25486 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 10.5MM 2028308 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 10.5MM 2028308 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 12X40MM 2028310 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 12X40MM 2028310 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE BTB 2028315 CDM 278 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE BTB 2028315 CDM 278 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ABS IMPLANT OPEN 2028316 CDM 278 RC facility both 582 582 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ABS IMPLANT OPEN 2028316 CDM 278 RC facility both 582 582 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER - ARTHREX AR-1204AF-110 2028318 CDM 272 RC facility both 1395 1395 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER - ARTHREX AR-1204AF-110 2028318 CDM 272 RC facility both 1395 1395 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TLC75 SINGLE INSTRUMENT 2028330 CDM 278 RC facility both 303 303 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TLC75 SINGLE INSTRUMENT 2028330 CDM 278 RC facility both 303 303 Gross Charge Type: NIHD_Hosp_Profee_Price CUTTER RELOAD UNIT 75MM 2028331 CDM 272 RC facility both 1641 1641 Gross Charge Type: NIHD_Hosp_Profee_Price CUTTER RELOAD UNIT 75MM 2028331 CDM 272 RC facility both 1641 1641 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 3 30X102MM 2028336 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 3 30X102MM 2028336 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price DISPOSABLE T3 AMZ KIT (ARTHREX) 2028337 CDM 272 RC facility both 2139 2139 Gross Charge Type: NIHD_Hosp_Profee_Price DISPOSABLE T3 AMZ KIT (ARTHREX) 2028337 CDM 272 RC facility both 2139 2139 Gross Charge Type: NIHD_Hosp_Profee_Price FOOT AND ANKLE SCP KIT (ZIMMER) 2028338 CDM 278 RC facility both 9175 9175 Gross Charge Type: NIHD_Hosp_Profee_Price FOOT AND ANKLE SCP KIT (ZIMMER) 2028338 CDM 278 RC facility both 9175 9175 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL CANNULATED S-CP 2.9X70MM 2028339 CDM 272 RC facility both 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL CANNULATED S-CP 2.9X70MM 2028339 CDM 272 RC facility both 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.6MM THD TROCAR TIP NS 2028340 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.6MM THD TROCAR TIP NS 2028340 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price 1.6MMX6IN STEIN PIN BAY TIP NS 2028341 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price 1.6MMX6IN STEIN PIN BAY TIP NS 2028341 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price COUNTERSINK CANN SCOUPLE 2028342 CDM 278 RC facility both 1289 1289 Gross Charge Type: NIHD_Hosp_Profee_Price COUNTERSINK CANN SCOUPLE 2028342 CDM 278 RC facility both 1289 1289 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANN CANC SM HD FT 55MM NS 2028343 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANN CANC SM HD FT 55MM NS 2028343 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANN CANC SM HD FT 65MM NS 2028344 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANN CANC SM HD FT 65MM NS 2028344 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price CARBON FIBER VECTRAN CONN ROD 8X200 2028346 CDM 272 RC facility both 1197 1197 Gross Charge Type: NIHD_Hosp_Profee_Price CARBON FIBER VECTRAN CONN ROD 8X200 2028346 CDM 272 RC facility both 1197 1197 Gross Charge Type: NIHD_Hosp_Profee_Price CARBON FIBER VECTRAN CONN ROD 8X250 2028347 CDM 272 RC facility both 1197 1197 Gross Charge Type: NIHD_Hosp_Profee_Price CARBON FIBER VECTRAN CONN ROD 8X250 2028347 CDM 272 RC facility both 1197 1197 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANN CANC SM HD FT 60MM NS 2028351 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANN CANC SM HD FT 60MM NS 2028351 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X300MM 2028359 CDM 272 RC facility both 1149 1149 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X300MM 2028359 CDM 272 RC facility both 1149 1149 Gross Charge Type: NIHD_Hosp_Profee_Price JGRLOC DISPOSABLE CANNULA KIT 2028366 CDM 272 RC facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price JGRLOC DISPOSABLE CANNULA KIT 2028366 CDM 272 RC facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 12 2028376 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 12 2028376 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP 36MM -3.5MM 2028377 CDM 278 RC facility both 4888 4888 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP 36MM -3.5MM 2028377 CDM 278 RC facility both 4888 4888 Gross Charge Type: NIHD_Hosp_Profee_Price HIP S1S HEAD CEMENT MOLD 48MM 2028402 CDM 278 RC facility both 5487 5487 Gross Charge Type: NIHD_Hosp_Profee_Price HIP S1S HEAD CEMENT MOLD 48MM 2028402 CDM 278 RC facility both 5487 5487 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZLB00 21.0 1 PIECE 3.25 2028405 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZLB00 21.0 1 PIECE 3.25 2028405 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price HIP HEAD CEMENT MOLD SIS 431197 2028420 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price HIP HEAD CEMENT MOLD SIS 431197 2028420 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS CEMENT 14X135MM 2028426 CDM 278 RC facility both 6836 6836 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS CEMENT 14X135MM 2028426 CDM 278 RC facility both 6836 6836 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX E- RIGHT 00595001402 2028428 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX E- RIGHT 00595001402 2028428 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL TRIPLE REAMER DHS 8.0MM 2028432 CDM 272 RC facility both 3508 3508 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL TRIPLE REAMER DHS 8.0MM 2028432 CDM 272 RC facility both 3508 3508 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULA ACCUPORT DELIVERY END TARGETING 2028434 CDM 272 RC facility both 1516 1516 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULA ACCUPORT DELIVERY END TARGETING 2028434 CDM 272 RC facility both 1516 1516 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL PROFILE COMP FT STANDARD 2028436 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL PROFILE COMP FT STANDARD 2028436 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT LT SM 2028443 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_RHC_Price DELUXE WRIST CONTOUR SPLINT LT SM 2028443 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_Clinic_Price DELUXE WRIST CONTOUR SPLINT LT SM 2028443 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT LT SM 2028443 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT LT MED 2028444 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_RHC_Price DELUXE WRIST CONTOUR SPLINT LT MED 2028444 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_Clinic_Price DELUXE WRIST CONTOUR SPLINT LT MED 2028444 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT LT MED 2028444 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT LT XLG 2028446 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_RHC_Price DELUXE WRIST CONTOUR SPLINT LT XLG 2028446 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_Clinic_Price DELUXE WRIST CONTOUR SPLINT LT XLG 2028446 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT LT XLG 2028446 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT RT SMALL 2028447 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_RHC_Price DELUXE WRIST CONTOUR SPLINT RT SMALL 2028447 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_Clinic_Price DELUXE WRIST CONTOUR SPLINT RT SMALL 2028447 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT RT SMALL 2028447 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT RT LG 2028449 CDM 274 RC L3908 HCPCS facility both 40 40 Gross Charge Type: NIHD_RHC_Price DELUXE WRIST CONTOUR SPLINT RT LG 2028449 CDM 274 RC L3908 HCPCS facility both 40 40 Gross Charge Type: NIHD_Clinic_Price DELUXE WRIST CONTOUR SPLINT RT LG 2028449 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT RT LG 2028449 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT RT XLG 2028450 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_RHC_Price DELUXE WRIST CONTOUR SPLINT RT XLG 2028450 CDM 274 RC L3908 HCPCS facility both 17 17 Gross Charge Type: NIHD_Clinic_Price DELUXE WRIST CONTOUR SPLINT RT XLG 2028450 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price DELUXE WRIST CONTOUR SPLINT RT XLG 2028450 CDM 274 RC facility both 17 17 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY TUBE 18 FR REPLACEMENT 2028452 CDM 272 RC facility both 634 634 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY TUBE 18 FR REPLACEMENT 2028452 CDM 272 RC facility both 634 634 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE OSTEOTOME THIN 10X21/2 MM 2028465 CDM 272 RC facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE OSTEOTOME THIN 10X21/2 MM 2028465 CDM 272 RC facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT RINGLOC 3.2X30MM BIOMET 2028466 CDM 272 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT RINGLOC 3.2X30MM BIOMET 2028466 CDM 272 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5MM CALIBRATED ARTHREX 2028488 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5MM CALIBRATED ARTHREX 2028488 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 22.5 3 PIECE 2028490 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 22.5 3 PIECE 2028490 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM NECK VERSYS SZ 13X14 FMMC 2028498 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM NECK VERSYS SZ 13X14 FMMC 2028498 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM +2.5M 2028502 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM +2.5M 2028502 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE 3-0 VICRYL RAPIDE ON CT-1 2028505 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE 3-0 VICRYL RAPIDE ON CT-1 2028505 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SWITCHCUT REAMER KIT 4.5X9.0MM 2028516 CDM 278 RC facility both 2099 2099 Gross Charge Type: NIHD_Hosp_Profee_Price SWITCHCUT REAMER KIT 4.5X9.0MM 2028516 CDM 278 RC facility both 2099 2099 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ML TAPER STD SZ 9 2028517 CDM 278 RC facility both 23926 23926 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ML TAPER STD SZ 9 2028517 CDM 278 RC facility both 23926 23926 Gross Charge Type: NIHD_Hosp_Profee_Price "SUTURE VICRYL 30"" 3-0 CV23" 2028532 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "SUTURE VICRYL 30"" 3-0 CV23" 2028532 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "MEDEBRA WMNS MED 34-36"" B-D" 2028535 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "MEDEBRA WMNS MED 34-36"" B-D" 2028535 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "MEDEBRA WMNS LG 38-40"" B-D" 2028536 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "MEDEBRA WMNS LG 38-40"" B-D" 2028536 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "MEDEBRA WMNS 1X 40-42"" B-D" 2028537 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "MEDEBRA WMNS 1X 40-42"" B-D" 2028537 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "XI STAPLER,SUREFORM 60,SPU,IS4000" 2028542 CDM 272 RC facility both 1589 1589 Gross Charge Type: NIHD_Hosp_Profee_Price "XI STAPLER,SUREFORM 60,SPU,IS4000" 2028542 CDM 272 RC facility both 1589 1589 Gross Charge Type: NIHD_Hosp_Profee_Price "XI RELOAD,SUREFORM 60,4.3 GREEN," 2028543 CDM 272 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price "XI RELOAD,SUREFORM 60,4.3 GREEN," 2028543 CDM 272 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price XI MONOPOLAR CURVED SCISSORS 2028547 CDM 272 RC facility both 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price XI MONOPOLAR CURVED SCISSORS 2028547 CDM 272 RC facility both 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price XI MARYLAND BIPOLAR FORCEPS 2028550 CDM 272 RC facility both 707 707 Gross Charge Type: NIHD_Hosp_Profee_Price XI MARYLAND BIPOLAR FORCEPS 2028550 CDM 272 RC facility both 707 707 Gross Charge Type: NIHD_Hosp_Profee_Price XI FENESTRATED BIPOLAR FORCEPS 2028551 CDM 272 RC facility both 707 707 Gross Charge Type: NIHD_Hosp_Profee_Price XI FENESTRATED BIPOLAR FORCEPS 2028551 CDM 272 RC facility both 707 707 Gross Charge Type: NIHD_Hosp_Profee_Price XI MEGA SUTURECUT NEEDLE DRIVER 2028553 CDM 272 RC facility both 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XI MEGA SUTURECUT NEEDLE DRIVER 2028553 CDM 272 RC facility both 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XI LARGE NEEDLE DRIVER 2028554 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XI LARGE NEEDLE DRIVER 2028554 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XI PROGRASP FORCEPS 2028555 CDM 272 RC facility both 506 506 Gross Charge Type: NIHD_Hosp_Profee_Price XI PROGRASP FORCEPS 2028555 CDM 272 RC facility both 506 506 Gross Charge Type: NIHD_Hosp_Profee_Price XI TIP-UP FENESTRATED GRASPER XI 2028556 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XI TIP-UP FENESTRATED GRASPER XI 2028556 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XI LARGE CLIP APPLIER XI 2028558 CDM 272 RC facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price XI LARGE CLIP APPLIER XI 2028558 CDM 272 RC facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price "XI 12 MM & STAPLER CANNULA, LONG" 2028559 CDM 272 RC facility both 3898 3898 Gross Charge Type: NIHD_Hosp_Profee_Price "XI 12 MM & STAPLER CANNULA, LONG" 2028559 CDM 272 RC facility both 3898 3898 Gross Charge Type: NIHD_Hosp_Profee_Price XI 12 MM & STAPLER CANNULA 2028560 CDM 272 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price XI 12 MM & STAPLER CANNULA 2028560 CDM 272 RC facility both 3748 3748 Gross Charge Type: NIHD_Hosp_Profee_Price "XI 12MM STAPLER BLADELESS OBTURATOR, LON" 2028561 CDM 272 RC facility both 2460 2460 Gross Charge Type: NIHD_Hosp_Profee_Price "XI 12MM STAPLER BLADELESS OBTURATOR, LON" 2028561 CDM 272 RC facility both 2460 2460 Gross Charge Type: NIHD_Hosp_Profee_Price "XI 8 MM INSTRUMENT CANNULA, LONG" 2028563 CDM 272 RC facility both 1949 1949 Gross Charge Type: NIHD_Hosp_Profee_Price "XI 8 MM INSTRUMENT CANNULA, LONG" 2028563 CDM 272 RC facility both 1949 1949 Gross Charge Type: NIHD_Hosp_Profee_Price XI 8 MM INSTRUMENT CANNULA 2028564 CDM 272 RC facility both 1800 1800 Gross Charge Type: NIHD_Hosp_Profee_Price XI 8 MM INSTRUMENT CANNULA 2028564 CDM 272 RC facility both 1800 1800 Gross Charge Type: NIHD_Hosp_Profee_Price XI 12 - 8 MM REDUCER 2028566 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price XI 12 - 8 MM REDUCER 2028566 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price "XI SEAL,IS4000 PORTS,12MM&STAPLER," 2028569 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price "XI SEAL,IS4000 PORTS,12MM&STAPLER," 2028569 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price "MEDEBRA WMNS SM 32-34"" A-C" 2028571 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "MEDEBRA WMNS SM 32-34"" A-C" 2028571 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "XI SUREFORM RELOAD 60, 2.5 WHITE" 2028572 CDM 272 RC facility both 723 723 Gross Charge Type: NIHD_Hosp_Profee_Price "XI SUREFORM RELOAD 60, 2.5 WHITE" 2028572 CDM 272 RC facility both 723 723 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE STRATAFIX 3-0 PDS 27 IN SH NDL 2028580 CDM 272 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE STRATAFIX 3-0 PDS 27 IN SH NDL 2028580 CDM 272 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 3H/RT/77 2028582 CDM facility both 3464 3464 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 3H/RT/77 2028582 CDM facility both 3464 3464 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 4H/LT/90 2028584 CDM 278 RC facility both 1990 1990 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 4H/LT/90 2028584 CDM 278 RC facility both 1990 1990 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLTE 5H/RT/103 2028585 CDM facility both 2311 2311 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLTE 5H/RT/103 2028585 CDM facility both 2311 2311 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLTE 5H/LT/103 2028586 CDM 278 RC facility both 2311 2311 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLTE 5H/LT/103 2028586 CDM 278 RC facility both 2311 2311 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 6H/RT116 2028587 CDM 278 RC facility both 2346 2346 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 6H/RT116 2028587 CDM 278 RC facility both 2346 2346 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 6H/LT116 2028588 CDM 278 RC facility both 3561 3561 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 6H/LT116 2028588 CDM 278 RC facility both 3561 3561 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 9H/LT155 2028592 CDM facility both 3662 3662 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7MM/3.5MM DISTAL FIBULA PLATE 9H/LT155 2028592 CDM facility both 3662 3662 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL QUICK RELEASE 1/8 INCH BIOMET 2028601 CDM 272 RC facility both 541 541 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL QUICK RELEASE 1/8 INCH BIOMET 2028601 CDM 272 RC facility both 541 541 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR SIZE H LEFT 2028604 CDM 278 RC facility both 14902 14902 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR SIZE H LEFT 2028604 CDM 278 RC facility both 14902 14902 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.4 X27MM DIA AO 2028605 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.4 X27MM DIA AO 2028605 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price DAVINCI XI CANNULA SEALS 5MM-8MM XI 2028616 CDM 272 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price DAVINCI XI CANNULA SEALS 5MM-8MM XI 2028616 CDM 272 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price ZONE NAVIGATOR CANNULA LEFT/MID/POSTER 2028619 CDM 272 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price ZONE NAVIGATOR CANNULA LEFT/MID/POSTER 2028619 CDM 272 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE MENISCUS REPAIR W/ 0.9MM TAPE 2028621 CDM 272 RC facility both 3448 3448 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE MENISCUS REPAIR W/ 0.9MM TAPE 2028621 CDM 272 RC facility both 3448 3448 Gross Charge Type: NIHD_Hosp_Profee_Price ZONENAVIGATOR CANNULA ANTERIOR 2028623 CDM 272 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price ZONENAVIGATOR CANNULA ANTERIOR 2028623 CDM 272 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 1 LEFT 2028659 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 1 LEFT 2028659 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT SZ1 X 11MM 2028662 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT SZ1 X 11MM 2028662 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT FEMORAL HEAD FF 2028712 CDM 278 RC facility both 1618 1618 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT FEMORAL HEAD FF 2028712 CDM 278 RC facility both 1618 1618 Gross Charge Type: NIHD_Hosp_Profee_Price ARISTA AH 1 GRAM 2028729 CDM 272 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price ARISTA AH 1 GRAM 2028729 CDM 272 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price ARISTA AH 3 GRAM 2028731 CDM 272 RC facility both 1019 1019 Gross Charge Type: NIHD_Hosp_Profee_Price ARISTA AH 3 GRAM 2028731 CDM 272 RC facility both 1019 1019 Gross Charge Type: NIHD_Hosp_Profee_Price MEDEBRA WOMENS SZ 2X 42-44 INCHES 2028735 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price MEDEBRA WOMENS SZ 2X 42-44 INCHES 2028735 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price LACERATION KIT MEDLINE 2028746 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price LACERATION KIT MEDLINE 2028746 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price MEDEBRA WOMENS SZ 3X 46-48INCHES 2028754 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price MEDEBRA WOMENS SZ 3X 46-48INCHES 2028754 CDM 270 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price PADDED ARM SLING (X-LARGE) 2028765 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price PADDED ARM SLING (X-LARGE) 2028765 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT9 23.0 2028792 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT9 23.0 2028792 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 36 +0 V40 2028795 CDM 278 RC facility both 7286 7286 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 36 +0 V40 2028795 CDM 278 RC facility both 7286 7286 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0MM VARIABLE ANGLE EXTENSION ARM 2028806 CDM 272 RC facility both 2549 2549 Gross Charge Type: NIHD_Hosp_Profee_Price 5.0MM VARIABLE ANGLE EXTENSION ARM 2028806 CDM 272 RC facility both 2549 2549 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 111 ARTHREX 2028814 CDM 272 RC facility both 1245 1245 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 111 ARTHREX 2028814 CDM 272 RC facility both 1245 1245 Gross Charge Type: NIHD_Hosp_Profee_Price ZONENAVIGATOR RIGHT MID/POST CANNULA 2028815 CDM 272 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price ZONENAVIGATOR RIGHT MID/POST CANNULA 2028815 CDM 272 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE CATCHER ARTHREX 2028816 CDM 272 RC facility both 1182 1182 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE CATCHER ARTHREX 2028816 CDM 272 RC facility both 1182 1182 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER 5515-F-302 2028852 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER 5515-F-302 2028852 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ3 11MM 2028853 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ3 11MM 2028853 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price "XI RELOAD,STAPLER 45 WHITE" 2028857 CDM 272 RC facility both 6285 6285 Gross Charge Type: NIHD_Hosp_Profee_Price "XI RELOAD,STAPLER 45 WHITE" 2028857 CDM 272 RC facility both 6285 6285 Gross Charge Type: NIHD_Hosp_Profee_Price "XI RELOAD,STAPLER 45 BLUE" 2028858 CDM 272 RC facility both 7196 7196 Gross Charge Type: NIHD_Hosp_Profee_Price "XI RELOAD,STAPLER 45 BLUE" 2028858 CDM 272 RC facility both 7196 7196 Gross Charge Type: NIHD_Hosp_Profee_Price PROX MEDIAL TIBIA 10 HOLE RIGHT 2028862 CDM 278 RC facility both 2756 2756 Gross Charge Type: NIHD_Hosp_Profee_Price PROX MEDIAL TIBIA 10 HOLE RIGHT 2028862 CDM 278 RC facility both 2756 2756 Gross Charge Type: NIHD_Hosp_Profee_Price PROX MEDIAL TIBIA 12 HOLE RIGHT 2028863 CDM 278 RC facility both 2836 2836 Gross Charge Type: NIHD_Hosp_Profee_Price PROX MEDIAL TIBIA 12 HOLE RIGHT 2028863 CDM 278 RC facility both 2836 2836 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO SCRW TM SS 2.7X22MM CORTEX 2028880 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO SCRW TM SS 2.7X22MM CORTEX 2028880 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO LOCK SCRW SS 2.7X12MM 2028881 CDM facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO LOCK SCRW SS 2.7X12MM 2028881 CDM facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price "LO-PRO SCRW TM,SS 3.5X12MM CORTEX" 2028883 CDM 278 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price "LO-PRO SCRW TM,SS 3.5X12MM CORTEX" 2028883 CDM 278 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price "LO-PRO LOCK SCRW,SS 3.5X10MM" 2028884 CDM facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price "LO-PRO LOCK SCRW,SS 3.5X10MM" 2028884 CDM facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price "LO-PRO LOCK SCRW,SS 3.5X12MM" 2028885 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price "LO-PRO LOCK SCRW,SS 3.5X12MM" 2028885 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.6MM CANNULATED 2028889 CDM 272 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.6MM CANNULATED 2028889 CDM 272 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE THRDED W/TRCR TIP 1.35MM 2028893 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE THRDED W/TRCR TIP 1.35MM 2028893 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DISTAL FIBULA LOCK SS LEFT 5 HOLE 2028895 CDM facility both 1949 1949 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DISTAL FIBULA LOCK SS LEFT 5 HOLE 2028895 CDM facility both 1949 1949 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT LINK 10 X 70 2028897 CDM facility both 7388 7388 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT LINK 10 X 70 2028897 CDM facility both 7388 7388 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X500MM 2028898 CDM 272 RC facility both 1487 1487 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X500MM 2028898 CDM 272 RC facility both 1487 1487 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT9 24.0 2028900 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT9 24.0 2028900 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW FULLY THREADED 4X40MM 20289000 CDM 278 RC facility both 354 354 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW FULLY THREADED 4X40MM 20289000 CDM 278 RC facility both 354 354 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE NEXGEN 7-10 BLUE 10MM 2028904 CDM 278 RC facility both 6417 6417 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE NEXGEN 7-10 BLUE 10MM 2028904 CDM 278 RC facility both 6417 6417 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 9 NEXGEN 2028905 CDM 278 RC facility both 10824 10824 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 9 NEXGEN 2028905 CDM 278 RC facility both 10824 10824 Gross Charge Type: NIHD_Hosp_Profee_Price ACL TIGHTROPE WITH FIBERTAG 2028910 CDM 278 RC facility both 1575 1575 Gross Charge Type: NIHD_Hosp_Profee_Price ACL TIGHTROPE WITH FIBERTAG 2028910 CDM 278 RC facility both 1575 1575 Gross Charge Type: NIHD_Hosp_Profee_Price "TIGHTROPE ACL WITH FIBERTAG, ABS" 2028911 CDM 278 RC facility both 1006 1006 Gross Charge Type: NIHD_Hosp_Profee_Price "TIGHTROPE ACL WITH FIBERTAG, ABS" 2028911 CDM 278 RC facility both 1006 1006 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 5 5515-F-501 2028914 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 5 5515-F-501 2028914 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ5 13MM 2028915 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ5 13MM 2028915 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price HEMOLOK M/L POLYMER CLIPS 2028916 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price HEMOLOK M/L POLYMER CLIPS 2028916 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X20MM 2028917 CDM 272 RC facility both 1267 1267 Gross Charge Type: NIHD_Hosp_Profee_Price HOFFMANN3 CONNECTING ROD DIA 11X20MM 2028917 CDM 272 RC facility both 1267 1267 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR AC GREEN 10MM 005976-40-14 2028924 CDM 278 RC facility both 5878 5878 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR AC GREEN 10MM 005976-40-14 2028924 CDM 278 RC facility both 5878 5878 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING JUMPSTART 4 X 4 (10CMX10CM) 2028932 CDM 272 RC facility both 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING JUMPSTART 4 X 4 (10CMX10CM) 2028932 CDM 272 RC facility both 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING JUMPSTART 1.5 X 8 (3.5CM X 20CM 2028934 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING JUMPSTART 1.5 X 8 (3.5CM X 20CM 2028934 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING JUMPSTART 6 X 115 15CMX29CM 2028935 CDM 272 RC facility both 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING JUMPSTART 6 X 115 15CMX29CM 2028935 CDM 272 RC facility both 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW N0N-LOCK 3.5MM HEX 4.75X15MM 2028941 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW N0N-LOCK 3.5MM HEX 4.75X15MM 2028941 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE SZ 54MM E 2028946 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE SZ 54MM E 2028946 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price JUGGERSTITCH STRAIGHT IMPLANT 2028969 CDM 278 RC facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price JUGGERSTITCH STRAIGHT IMPLANT 2028969 CDM 278 RC facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price JUGGERSTITCH CURVED IMPLANT 2028970 CDM 278 RC facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price JUGGERSTITCH CURVED IMPLANT 2028970 CDM 278 RC facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price JUGGERSTITCH SUTURE CUTTER 2028972 CDM 272 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price JUGGERSTITCH SUTURE CUTTER 2028972 CDM 272 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price MARYLAND LIGASURE XP SEALER/DIVIDER ONE STEP SEALING 37 CM 20289758 CDM 272 RC facility both 1576 1576 Gross Charge Type: NIHD_Hosp_Profee_Price MARYLAND LIGASURE XP SEALER/DIVIDER ONE STEP SEALING 37 CM 20289758 CDM 272 RC facility both 1576 1576 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL V40 SZ 28MM +0MM 2028985 CDM 278 RC facility both 3832 3832 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL V40 SZ 28MM +0MM 2028985 CDM 278 RC facility both 3832 3832 Gross Charge Type: NIHD_Hosp_Profee_Price UNIVERSAL HEAD BIPOLAR COMPONENT 2028986 CDM 278 RC facility both 5176 5176 Gross Charge Type: NIHD_Hosp_Profee_Price UNIVERSAL HEAD BIPOLAR COMPONENT 2028986 CDM 278 RC facility both 5176 5176 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 195MM X 18 MM 2028988 CDM 278 RC facility both 18030 18030 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 195MM X 18 MM 2028988 CDM 278 RC facility both 18030 18030 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 21 +0 V40 2028989 CDM 278 RC facility both 22515 22515 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 21 +0 V40 2028989 CDM 278 RC facility both 22515 22515 Gross Charge Type: NIHD_Hosp_Profee_Price TRIDENT X3 O DEGREE POLYETHYLENE INSERT SZ 36MM E 2028990 CDM 278 RC facility both 9217 9217 Gross Charge Type: NIHD_Hosp_Profee_Price TRIDENT X3 O DEGREE POLYETHYLENE INSERT SZ 36MM E 2028990 CDM 278 RC facility both 9217 9217 Gross Charge Type: NIHD_Hosp_Profee_Price INSIGNIA HIP STEM SZ 3 X32.5 X 101 2028991 CDM 278 RC facility both 32025 32025 Gross Charge Type: NIHD_Hosp_Profee_Price INSIGNIA HIP STEM SZ 3 X32.5 X 101 2028991 CDM 278 RC facility both 32025 32025 Gross Charge Type: NIHD_Hosp_Profee_Price QUATTRO LINK SP KNOTLESS ANCHOR 4.5 MM 2028992 CDM 278 RC facility both 2039 2039 Gross Charge Type: NIHD_Hosp_Profee_Price QUATTRO LINK SP KNOTLESS ANCHOR 4.5 MM 2028992 CDM 278 RC facility both 2039 2039 Gross Charge Type: NIHD_Hosp_Profee_Price QUATTRO LINK KNOTLESS ANCHOR 4.5 MM 2028993 CDM 278 RC facility both 1949 1949 Gross Charge Type: NIHD_Hosp_Profee_Price QUATTRO LINK KNOTLESS ANCHOR 4.5 MM 2028993 CDM 278 RC facility both 1949 1949 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 5 2028999 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 5 2028999 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price UROLIFT® SYSTEM 2029000 CDM facility both 2925 2925 Gross Charge Type: NIHD_Hosp_Profee_Price UROLIFT® SYSTEM 2029000 CDM facility both 2925 2925 Gross Charge Type: NIHD_Hosp_Profee_Price ACHILLES MIDSUBSTANCE SPEED BRIDGE 2029031 CDM 278 RC facility both 2925 2925 Gross Charge Type: NIHD_Hosp_Profee_Price ACHILLES MIDSUBSTANCE SPEED BRIDGE 2029031 CDM 278 RC facility both 2925 2925 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERTAPE BLU W/NDLS 17 IN TAPE 2029032 CDM 272 RC facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERTAPE BLU W/NDLS 17 IN TAPE 2029032 CDM 272 RC facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE SILK 0 30 INCHES 424H 2029035 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE SILK 0 30 INCHES 424H 2029035 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING DISTAL FIBULA PLATE RIGHT 4 HOLE 2029036 CDM 278 RC facility both 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING DISTAL FIBULA PLATE RIGHT 4 HOLE 2029036 CDM 278 RC facility both 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price BB-TAK SMOOTH 2029037 CDM 278 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price BB-TAK SMOOTH 2029037 CDM 278 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.5 X 14MM 2029038 CDM 278 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.5 X 14MM 2029038 CDM 278 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING 3.5 X 14MM 2029040 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING 3.5 X 14MM 2029040 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSED INSERT 36X6X12.5 2029074 CDM facility both 6935 6935 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSED INSERT 36X6X12.5 2029074 CDM facility both 6935 6935 Gross Charge Type: NIHD_Hosp_Profee_Price ASCEND FLEX ECCENTRIC REVERSEDTRAY DIA 4 2029075 CDM 278 RC facility both 7053 7053 Gross Charge Type: NIHD_Hosp_Profee_Price ASCEND FLEX ECCENTRIC REVERSEDTRAY DIA 4 2029075 CDM 278 RC facility both 7053 7053 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED STANDARD GLENOSPHERE 36 2029076 CDM facility both 18799 18799 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED STANDARD GLENOSPHERE 36 2029076 CDM facility both 18799 18799 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED STANDARD BASEPLATE 29 M 2029077 CDM facility both 10003 10003 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED STANDARD BASEPLATE 29 M 2029077 CDM facility both 10003 10003 Gross Charge Type: NIHD_Hosp_Profee_Price AEQUALIS PERFORM+ GUIDE PIN 2.5MMX220MM 2029078 CDM 272 RC facility both 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price AEQUALIS PERFORM+ GUIDE PIN 2.5MMX220MM 2029078 CDM 272 RC facility both 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERALSCREW DRILL B 2029079 CDM 272 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERALSCREW DRILL B 2029079 CDM 272 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERAL SCREW 5.0MM DWJ338 2029080 CDM facility both 993 993 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERAL SCREW 5.0MM DWJ338 2029080 CDM facility both 993 993 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERAL SCREW 5.0MM DWJ330 2029081 CDM facility both 993 993 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERAL SCREW 5.0MM DWJ330 2029081 CDM facility both 993 993 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERAL SCREW 5.0MM DWJ318 2029082 CDM facility both 993 993 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERAL SCREW 5.0MM DWJ318 2029082 CDM facility both 993 993 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED CENTRAL SCREW6.5MM X 35 2029083 CDM facility both 3334 3334 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED CENTRAL SCREW6.5MM X 35 2029083 CDM facility both 3334 3334 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERAL SCREW 5.0MM DWJ334 2029084 CDM facility both 993 993 Gross Charge Type: NIHD_Hosp_Profee_Price PERFORM REVERSED PERIPHERAL SCREW 5.0MM DWJ334 2029084 CDM facility both 993 993 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE SZ 52MM E 2029089 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE SZ 52MM E 2029089 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 X 20MM LOW PROFILE HEX 2029090 CDM 278 RC facility both 570 570 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 X 20MM LOW PROFILE HEX 2029090 CDM 278 RC facility both 570 570 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE CLAVICLE SMALL CURVE LEFT 8 HOLE 2029096 CDM 278 RC facility both 2549 2549 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE CLAVICLE SMALL CURVE LEFT 8 HOLE 2029096 CDM 278 RC facility both 2549 2549 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE-K 0.062X3IN ARTHREX 2029097 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE-K 0.062X3IN ARTHREX 2029097 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE NON-LOCK 3.5X16MM 2029115 CDM 278 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE NON-LOCK 3.5X16MM 2029115 CDM 278 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO PROFILE NON-LOCK CORT 3.5X16MM 2029119 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO PROFILE NON-LOCK CORT 3.5X16MM 2029119 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT 8MM CANNULA INSERTER 2029129 CDM facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT 8MM CANNULA INSERTER 2029129 CDM facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT 10MM CANNULA INSERTER 2029130 CDM facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT 10MM CANNULA INSERTER 2029130 CDM facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price SWITCHING STICK 2.6MM X 305MM 2029131 CDM facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price SWITCHING STICK 2.6MM X 305MM 2029131 CDM facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price "NANOGRASPER, STRAIGHT 70 MM DISPOSABLE" 2029138 CDM 272 RC facility both 796 796 Gross Charge Type: NIHD_Hosp_Profee_Price "NANOGRASPER, STRAIGHT 70 MM DISPOSABLE" 2029138 CDM 272 RC facility both 796 796 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE MIC 24FR 2029140 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE MIC 24FR 2029140 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE MIC 22FR 2029141 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE MIC 22FR 2029141 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 10MM NON-LOCKING HEXALOBE SCREW 2029162 CDM facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 10MM NON-LOCKING HEXALOBE SCREW 2029162 CDM facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 18MM NON-LOCKING HEXALOBE SCREW 2029163 CDM facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 18MM NON-LOCKING HEXALOBE SCREW 2029163 CDM facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price ACU-LOC® VDU PLATE LEFT LONG 2029164 CDM facility both 4654 4654 Gross Charge Type: NIHD_Hosp_Profee_Price ACU-LOC® VDU PLATE LEFT LONG 2029164 CDM facility both 4654 4654 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3MM X 14MM NON-TOGGLING CORTICAL SCREW 2029165 CDM facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3MM X 14MM NON-TOGGLING CORTICAL SCREW 2029165 CDM facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE TACK 2029166 CDM facility both 280 280 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE TACK 2029166 CDM facility both 280 280 Gross Charge Type: NIHD_Hosp_Profee_Price Pressure Injectable One-Lumen PICC 2029188 CDM 278 RC facility both 344 344 Gross Charge Type: NIHD_Hosp_Profee_Price Pressure Injectable One-Lumen PICC 2029188 CDM 278 RC facility both 344 344 Gross Charge Type: NIHD_Hosp_Profee_Price POW-TRIALYSIS SHORT TERM CATH 20CM DIALY 2029189 CDM facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price POW-TRIALYSIS SHORT TERM CATH 20CM DIALY 2029189 CDM facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price POW-TRIALYSIS SLIM CATH 215CM BASIC KIT 2029190 CDM facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price POW-TRIALYSIS SLIM CATH 215CM BASIC KIT 2029190 CDM facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL LOCK 2.3X14MM ACUMED 2029231 CDM facility both 499 499 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL LOCK 2.3X14MM ACUMED 2029231 CDM facility both 499 499 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 12MM NON-LOCKING HEXALOBE SCREW 2029232 CDM facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 12MM NON-LOCKING HEXALOBE SCREW 2029232 CDM facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price ACU-LOC® EX STANDARD PLATE 2029234 CDM facility both 4294 4294 Gross Charge Type: NIHD_Hosp_Profee_Price ACU-LOC® EX STANDARD PLATE 2029234 CDM facility both 4294 4294 Gross Charge Type: NIHD_Hosp_Profee_Price HEMODIALYSIS CATHETER SET 15.5F X 24CM 2029240 CDM 278 RC facility both 796 796 Gross Charge Type: NIHD_Hosp_Profee_Price HEMODIALYSIS CATHETER SET 15.5F X 24CM 2029240 CDM 278 RC facility both 796 796 Gross Charge Type: NIHD_Hosp_Profee_Price PALINDROME - P 19/36 VT SPORT CATH 14.5F 2029241 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PALINDROME - P 19/36 VT SPORT CATH 14.5F 2029241 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PALINDROME - P 23/40 VT SPORT CATH 14.5F 2029242 CDM facility both 1530 1530 Gross Charge Type: NIHD_Hosp_Profee_Price PALINDROME - P 23/40 VT SPORT CATH 14.5F 2029242 CDM facility both 1530 1530 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL LOCK 2.3X14MM ACCUMED 2029245 CDM 278 RC facility both 499 499 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL LOCK 2.3X14MM ACCUMED 2029245 CDM 278 RC facility both 499 499 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE LOCK 3.5MMX10MM 2029246 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE LOCK 3.5MMX10MM 2029246 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE NON-LOCK 3.5MMX12MM 2029247 CDM 278 RC facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE NON-LOCK 3.5MMX12MM 2029247 CDM 278 RC facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE SZ 62MM G 2029260 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE SZ 62MM G 2029260 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 8 37X117MM 2029262 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 8 37X117MM 2029262 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM STANDARD OFFSET 5X105MM 20292621 CDM 278 RC facility both 26688 26688 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM STANDARD OFFSET 5X105MM 20292621 CDM 278 RC facility both 26688 26688 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 36 X +0MM 2029273 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 36 X +0MM 2029273 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DISTAL FIBULA RIGHT 5 HOLE 2029278 CDM 278 RC facility both 1949 1949 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DISTAL FIBULA RIGHT 5 HOLE 2029278 CDM 278 RC facility both 1949 1949 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 16 2029281 CDM facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 16 2029281 CDM facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 18 2029282 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 18 2029282 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 20 2029283 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 20 2029283 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR MICRO CORKSCREW 2-0 FIBERW 2029286 CDM facility both 856 856 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR MICRO CORKSCREW 2-0 FIBERW 2029286 CDM facility both 856 856 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR NANO CORKSCREW 3-0 FIBERWI 2029287 CDM 272 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR NANO CORKSCREW 3-0 FIBERWI 2029287 CDM 272 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY IC 16FR DL TMP SENS W/UR METR 2029302 CDM 272 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY IC 16FR DL TMP SENS W/UR METR 2029302 CDM 272 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY IC 16FR TMP SENS W/UR METR DOV 2029303 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY IC 16FR TMP SENS W/UR METR DOV 2029303 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM +5MM 2029315 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM +5MM 2029315 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.0X15MM 2029316 CDM 272 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.0X15MM 2029316 CDM 272 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.0X15MM AO 2029317 CDM 272 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price TWIST DRILL 1.0X15MM AO 2029317 CDM 272 RC facility both 413 413 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 15.0 2029321 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 15.0 2029321 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMB00 11.0 1 PIECE 2029355 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMB00 11.0 1 PIECE 2029355 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 10.5 3 PIECE 2029357 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 10.5 3 PIECE 2029357 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY 5X5 25 SQ CM 2029364 CDM 278 RC facility both 7202 7202 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY 5X5 25 SQ CM 2029364 CDM 278 RC facility both 7202 7202 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 1.6 SQ CM DISC 2029365 CDM 636 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 1.6 SQ CM DISC 2029365 CDM 636 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 2X2 4 SQ CM 2029366 CDM 636 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 2X2 4 SQ CM 2029366 CDM 636 RC facility both 2249 2249 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 2X4 8 SQ CM 2029367 CDM 636 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 2X4 8 SQ CM 2029367 CDM 636 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 5X5 25 SQ CM 2029368 CDM 278 RC facility both 8246 8246 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 5X5 25 SQ CM 2029368 CDM 278 RC facility both 8246 8246 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 6X9 54 SQ CM 2029369 CDM 278 RC facility both 17810 17810 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 6X9 54 SQ CM 2029369 CDM 278 RC facility both 17810 17810 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 8X16 128 SQ CM 2029370 CDM 278 RC facility both 41975 41975 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 8X16 128 SQ CM 2029370 CDM 278 RC facility both 41975 41975 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 6 2029372 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 6 2029372 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 6 11MM 2029373 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 6 11MM 2029373 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL HEAD 22.0MM LEFT 2029377 CDM 278 RC facility both 16179 16179 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL HEAD 22.0MM LEFT 2029377 CDM 278 RC facility both 16179 16179 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL STEM 8.0 X0.0MM 2029378 CDM 278 RC facility both 9473 9473 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL STEM 8.0 X0.0MM 2029378 CDM 278 RC facility both 9473 9473 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 26 2029381 CDM facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 26 2029381 CDM facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE CLAVICLE CENTRAL THIRD CURVE LEFT 2029383 CDM facility both 2549 2549 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE CLAVICLE CENTRAL THIRD CURVE LEFT 2029383 CDM facility both 2549 2549 Gross Charge Type: NIHD_Hosp_Profee_Price POWER PICC CATHETER KIT TWO LUMEN 2029395 CDM 272 RC facility both 281 281 Gross Charge Type: NIHD_Hosp_Profee_Price POWER PICC CATHETER KIT TWO LUMEN 2029395 CDM 272 RC facility both 281 281 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 5 5515-F-502 2029396 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 5 5515-F-502 2029396 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DISTAL FIBULA LOCK SS LEFT 6 HOLE 2029400 CDM facility both 2175 2175 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DISTAL FIBULA LOCK SS LEFT 6 HOLE 2029400 CDM facility both 2175 2175 Gross Charge Type: NIHD_Hosp_Profee_Price ARH SOLUTIONS 2 HEAD 20MM LEFT 2029411 CDM 278 RC facility both 16179 16179 Gross Charge Type: NIHD_Hosp_Profee_Price ARH SOLUTIONS 2 HEAD 20MM LEFT 2029411 CDM 278 RC facility both 16179 16179 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 10.0 3 PIECE 2029417 CDM facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 10.0 3 PIECE 2029417 CDM facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Primary Tubing CONNECTOR 15 DROPS/ML UNIVER SPIKE 2029418 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price Primary Tubing CONNECTOR 15 DROPS/ML UNIVER SPIKE 2029418 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 7 37X114MM 2029442 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 7 37X114MM 2029442 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM CEMENTED 15X50MM 2029444 CDM 278 RC facility both 6264 6264 Gross Charge Type: NIHD_Hosp_Profee_Price STEM CEMENTED 15X50MM 2029444 CDM 278 RC facility both 6264 6264 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL INSERT TOTAL STABILIZER SZ 3X19M 2029445 CDM 278 RC facility both 12530 12530 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL INSERT TOTAL STABILIZER SZ 3X19M 2029445 CDM 278 RC facility both 12530 12530 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIGRAFT QUADLINK-ZORC 10X70 2029455 CDM 278 RC facility both 7795 7795 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIGRAFT QUADLINK-ZORC 10X70 2029455 CDM 278 RC facility both 7795 7795 Gross Charge Type: NIHD_Hosp_Profee_Price 10MM TENDON STRIPPER BLADE 2029458 CDM 272 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price 10MM TENDON STRIPPER BLADE 2029458 CDM 272 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ABS BUTTON ROUND CONCAVE 14 2029460 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ABS BUTTON ROUND CONCAVE 14 2029460 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ABS BUTTON ROUND CONCAVE 20 2029461 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ABS BUTTON ROUND CONCAVE 20 2029461 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE SUTURE TENSIONER 2029462 CDM facility both 2474 2474 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE SUTURE TENSIONER 2029462 CDM facility both 2474 2474 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMB00 19.0 3 PIECE 2029464 CDM facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMB00 19.0 3 PIECE 2029464 CDM facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price "PEEK, MENISCAL ROOT REPAIR KIT" 2029472 CDM 278 RC facility both 4184 4184 Gross Charge Type: NIHD_Hosp_Profee_Price "PEEK, MENISCAL ROOT REPAIR KIT" 2029472 CDM 278 RC facility both 4184 4184 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERLINK SUTURETAPE 0.9MM WH/BL 2029473 CDM facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERLINK SUTURETAPE 0.9MM WH/BL 2029473 CDM facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE 6.5X25MM SELF TAPPING 2029485 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE 6.5X25MM SELF TAPPING 2029485 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E CARDIERE FORCEPS 2029495 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E CARDIERE FORCEPS 2029495 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E PROGRASP FORCEPS 2029496 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E PROGRASP FORCEPS 2029496 CDM 272 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E LARGE NEEDLE DRIVER 2029497 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E LARGE NEEDLE DRIVER 2029497 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E MEGA SUTURECUT NEEDLE DRIVER 2029498 CDM 272 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E MEGA SUTURECUT NEEDLE DRIVER 2029498 CDM 272 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E MARYLAND BIPOLAR FORCEPS 2029499 CDM 272 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E MARYLAND BIPOLAR FORCEPS 2029499 CDM 272 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E FENESTRATED BIPOLAR FORCEPS 2029500 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E FENESTRATED BIPOLAR FORCEPS 2029500 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E CURVED BIPOLAR DISSECTOR XI 2029501 CDM 272 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E CURVED BIPOLAR DISSECTOR XI 2029501 CDM 272 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E LONG BIPOLAR GRASPER 2029502 CDM 272 RC facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price XI-E LONG BIPOLAR GRASPER 2029502 CDM 272 RC facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price "XI-E 8MM,FORCE BIPOLAR,IS4000" 2029503 CDM 272 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price "XI-E 8MM,FORCE BIPOLAR,IS4000" 2029503 CDM 272 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETENE 1515 6X6 FLAT SHEET 2029508 CDM 278 RC facility both 287 287 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETENE 1515 6X6 FLAT SHEET 2029508 CDM 278 RC facility both 287 287 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PRE SHAPED K-HOLE 6 X 13 2029525 CDM 278 RC facility both 1042 1042 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PRE SHAPED K-HOLE 6 X 13 2029525 CDM 278 RC facility both 1042 1042 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIGRAFT QUADLINK(9.5X71) 2029531 CDM 278 RC facility both 7406 7406 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIGRAFT QUADLINK(9.5X71) 2029531 CDM 278 RC facility both 7406 7406 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X10MM 2029596 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X10MM 2029596 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price "XI STAPLER,SUREFORM 40,SPU,IS4000" 2029604 CDM 272 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price "XI STAPLER,SUREFORM 40,SPU,IS4000" 2029604 CDM 272 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price ELELECTRODE BIPOLAR VAP DISC 24 FR 2029609 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price ELELECTRODE BIPOLAR VAP DISC 24 FR 2029609 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE W TROCAR THREADED 2 X 130MM 2029613 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE W TROCAR THREADED 2 X 130MM 2029613 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PRESHAPED KEYHOLE1.8 X4.0 2029629 CDM 272 RC facility both 417 417 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PRESHAPED KEYHOLE1.8 X4.0 2029629 CDM 272 RC facility both 417 417 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 1.7 MM LASER MARKED 2029675 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 1.7 MM LASER MARKED 2029675 CDM 272 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price CORKSCREW 3.9 MM KNOTLESS W/SPEAR 2029691 CDM facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price CORKSCREW 3.9 MM KNOTLESS W/SPEAR 2029691 CDM facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR SWIVLOCK/TIT W #2FIBERWIRE 2029693 CDM 272 RC facility both 1260 1260 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR SWIVLOCK/TIT W #2FIBERWIRE 2029693 CDM 272 RC facility both 1260 1260 Gross Charge Type: NIHD_Hosp_Profee_Price PERCUTNEOUS INSERTION 3.0 KIT 2029704 CDM facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price PERCUTNEOUS INSERTION 3.0 KIT 2029704 CDM facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price URET BALLOON UROMA 15CM X 4CM 2029728 CDM 272 RC facility both 1724 1724 Gross Charge Type: NIHD_Hosp_Profee_Price URET BALLOON UROMA 15CM X 4CM 2029728 CDM 272 RC facility both 1724 1724 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS FIBERTAK 1.8MM CURVED 2029732 CDM 278 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS FIBERTAK 1.8MM CURVED 2029732 CDM 278 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA REFILL 30-3.5 30452 2029736 CDM facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA REFILL 30-3.5 30452 2029736 CDM facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 CANNULATED 30 X 16 MM 2029742 CDM facility both 1521 1521 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 CANNULATED 30 X 16 MM 2029742 CDM facility both 1521 1521 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 CANNULATED 35 X 16 MM 2029743 CDM facility both 1521 1521 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 CANNULATED 35 X 16 MM 2029743 CDM facility both 1521 1521 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 60 MM G 2029751 CDM 278 RC facility both 10641 10641 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 60 MM G 2029751 CDM 278 RC facility both 10641 10641 Gross Charge Type: NIHD_Hosp_Profee_Price Fibertak 2.6 RC black and blue 2029788 CDM 278 RC facility both 1477 1477 Gross Charge Type: NIHD_Hosp_Profee_Price Fibertak 2.6 RC black and blue 2029788 CDM 278 RC facility both 1477 1477 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERTAK 2.6 RC WHITE AND BLACK 2029790 CDM 278 RC facility both 1477 1477 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERTAK 2.6 RC WHITE AND BLACK 2029790 CDM 278 RC facility both 1477 1477 Gross Charge Type: NIHD_Hosp_Profee_Price ASM-EVAC1 TRI-LUMEN FILTERED TUBE SET (AIRSEAL) 2029812 CDM 272 RC facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price ASM-EVAC1 TRI-LUMEN FILTERED TUBE SET (AIRSEAL) 2029812 CDM 272 RC facility both 237 237 Gross Charge Type: NIHD_Hosp_Profee_Price ASM-EVAC1-B 1FURCATED FILTERED TUBE (AIR-SEAL) 2029813 CDM 272 RC facility both 315 315 Gross Charge Type: NIHD_Hosp_Profee_Price ASM-EVAC1-B 1FURCATED FILTERED TUBE (AIR-SEAL) 2029813 CDM 272 RC facility both 315 315 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 12/120MM LPI PORT 2029814 CDM 272 RC facility both 246 246 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 12/120MM LPI PORT 2029814 CDM 272 RC facility both 246 246 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 5/100MM LPI PORT 2029815 CDM 272 RC facility both 231 231 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 5/100MM LPI PORT 2029815 CDM 272 RC facility both 231 231 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 5/120MM PORT 2029816 CDM 272 RC facility both 231 231 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 5/120MM PORT 2029816 CDM 272 RC facility both 231 231 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 8/120MM PORT 2029817 CDM 272 RC facility both 231 231 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 8/120MM PORT 2029817 CDM 272 RC facility both 231 231 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 5 11MM 2029873 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 5 11MM 2029873 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X12MM 2029907 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X12MM 2029907 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price STEM TRIATHLON CEMENTED 2029925 CDM 278 RC facility both 6519 6519 Gross Charge Type: NIHD_Hosp_Profee_Price STEM TRIATHLON CEMENTED 2029925 CDM 278 RC facility both 6519 6519 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 1 2029950 CDM 278 RC facility both 16363 16363 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 1 2029950 CDM 278 RC facility both 16363 16363 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 2 13MM 2029952 CDM 278 RC facility both 11269 11269 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 2 13MM 2029952 CDM 278 RC facility both 11269 11269 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 Cortical Screws Synthes 40mm 2043400 CDM 278 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 Cortical Screws Synthes 40mm 2043400 CDM 278 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 Cortical Screw Synthes 60mm 2043600 CDM 278 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 Cortical Screw Synthes 60mm 2043600 CDM 278 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price 20520 Removal of foreign body in muscle or tendon sheath; simple 205201 CDM 521 RC 20520 HCPCS facility both 450 450 Gross Charge Type: NIHD_RHC_Price 20520 Removal of foreign body in muscle or tendon sheath; simple 205201 CDM 521 RC 20520 HCPCS facility both 450 450 Gross Charge Type: NIHD_Clinic_Price 20520 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE TechFee 205202 CDM 450 RC facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price 20520 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE TechFee 205202 CDM 450 RC facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price 20520 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE ProFee 205203 CDM 982 RC 20520 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 20520 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE ProFee 205203 CDM 982 RC 20520 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 20525 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED ProFee 20525 CDM 982 RC 20525 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price 20525 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED ProFee 20525 CDM 982 RC 20525 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price "20526 Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel" 205261 CDM 521 RC 20526 HCPCS facility both 341 341 Gross Charge Type: NIHD_RHC_Price "20526 Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel" 205261 CDM 521 RC 20526 HCPCS facility both 341 341 Gross Charge Type: NIHD_Clinic_Price 20526 INJECT CARPAL TUNNEL CHARGE 205262 CDM 761 RC facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price 20526 INJECT CARPAL TUNNEL CHARGE 205262 CDM 761 RC facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price "20527 Injection, enzyme, palmar fascial cord (Dupuytren's contracture)" 20527 CDM 521 RC 20527 HCPCS facility both 153 153 Gross Charge Type: NIHD_RHC_Price "20527 Injection, enzyme, palmar fascial cord (Dupuytren's contracture)" 20527 CDM 521 RC 20527 HCPCS facility both 153 153 Gross Charge Type: NIHD_Clinic_Price INJ TENDON SHEATH/LIGAMENT 20550 CDM 521 RC 20550 HCPCS facility both 462 462 Gross Charge Type: NIHD_RHC_Price INJ TENDON SHEATH/LIGAMENT 20550 CDM 521 RC 20550 HCPCS facility both 198 198 Gross Charge Type: NIHD_Clinic_Price 20551 Injection(s); single tendon origin/insertion 20551 CDM 521 RC 20551 HCPCS facility both 473 473 Gross Charge Type: NIHD_RHC_Price 20551 Injection(s); single tendon origin/insertion 20551 CDM 521 RC 20551 HCPCS facility both 266 266 Gross Charge Type: NIHD_Clinic_Price "20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)" 205521 CDM 521 RC 20552 HCPCS facility both 437 437 Gross Charge Type: NIHD_RHC_Price "20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)" 205521 CDM 521 RC 20552 HCPCS facility both 215 215 Gross Charge Type: NIHD_Clinic_Price 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES TechFee 205522 CDM 450 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES TechFee 205522 CDM 450 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price "20552 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S) ProFee" 205523 CDM 982 RC 20552 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price "20552 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S) ProFee" 205523 CDM 982 RC 20552 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Muscle 205524 CDM 761 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Muscle 205524 CDM 761 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Trigger Pnt 1 or 2 Muscles 205526 CDM 761 RC facility both TC 733 733 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Trigger Pnt 1 or 2 Muscles 205526 CDM 761 RC facility both TC 733 733 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Trigger Pnt 1 or 2 Muscles - Report 205527 CDM 982 RC 20552 HCPCS facility both 26 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Trigger Pnt 1 or 2 Muscles - Report 205527 CDM 982 RC 20552 HCPCS facility both 26 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR TRIGGER POINT INJ 3+ MUSCLES 20553 CDM 761 RC facility both TC 791 791 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR TRIGGER POINT INJ 3+ MUSCLES 20553 CDM 761 RC facility both TC 791 791 Gross Charge Type: NIHD_Hosp_Profee_Price "20553 Injection(s); single or multiple trigger point(s), 3 or more muscle(s)" 205531 CDM 521 RC 20553 HCPCS facility both 654 654 Gross Charge Type: NIHD_RHC_Price "20553 Injection(s); single or multiple trigger point(s), 3 or more muscle(s)" 205531 CDM 521 RC 20553 HCPCS facility both 654 654 Gross Charge Type: NIHD_Clinic_Price 20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES TechFee 205532 CDM 450 RC facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price 20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES TechFee 205532 CDM 450 RC facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price "20553 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES ProFee" 205533 CDM 982 RC 20553 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price "20553 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES ProFee" 205533 CDM 982 RC 20553 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR TRIGGER POINT INJ 3+ MUSCLES 205534 CDM 761 RC facility both TC 791 791 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR TRIGGER POINT INJ 3+ MUSCLES 205534 CDM 761 RC facility both TC 791 791 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Trigger Pnt 3+ Muscles 205535 CDM 761 RC facility both TC 791 791 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Trigger Pnt 3+ Muscles 205535 CDM 761 RC facility both TC 791 791 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Trigger Pnt 3+ Muscles - Report 205536 CDM 982 RC 20553 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Trigger Pnt 3+ Muscles - Report 205536 CDM 982 RC 20553 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price 20560 Needle insertion(s) without injection(s); 1 or 2 muscle(s) 20560 CDM 521 RC 20560 HCPCS facility both 80 80 Gross Charge Type: NIHD_RHC_Price 20560 Needle insertion(s) without injection(s); 1 or 2 muscle(s) 20560 CDM 521 RC 20560 HCPCS facility both 84 84 Gross Charge Type: NIHD_Clinic_Price DRN/INJ SML JT/BRSA W/O US 206001 CDM 521 RC 20600 HCPCS facility both 600 600 Gross Charge Type: NIHD_RHC_Price DRN/INJ SML JT/BRSA W/O US 206001 CDM 521 RC 20600 HCPCS facility both 262 262 Gross Charge Type: NIHD_Clinic_Price 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US TechFee 206002 CDM 450 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US TechFee 206002 CDM 450 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); ProFee" 206004 CDM 982 RC 20600 HCPCS facility both 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price "20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); ProFee" 206004 CDM 982 RC 20600 HCPCS facility both 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Small Arthr/Asp/Inj Left 206005 CDM 761 RC facility both TCLT 587 587 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Small Arthr/Asp/Inj Left 206005 CDM 761 RC facility both TCLT 587 587 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Small Arthr/Asp/Inj Left - Report 206006 CDM 982 RC 20600 HCPCS facility both 26LT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Small Arthr/Asp/Inj Left - Report 206006 CDM 982 RC 20600 HCPCS facility both 26LT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 20600 ARTHROC ASPI/INJ;SM JNT/BURSA CHARGE 206007 CDM 761 RC facility both 673 673 Gross Charge Type: NIHD_Hosp_Profee_Price 20600 ARTHROC ASPI/INJ;SM JNT/BURSA CHARGE 206007 CDM 761 RC facility both 673 673 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Small Arthr/Asp/Inj Right 206008 CDM 761 RC facility both TCRT 587 587 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Small Arthr/Asp/Inj Right 206008 CDM 761 RC facility both TCRT 587 587 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Small Arthr/Asp/Inj Right - Report 206009 CDM 982 RC 20600 HCPCS facility both 26RT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Small Arthr/Asp/Inj Right - Report 206009 CDM 982 RC 20600 HCPCS facility both 26RT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 20604 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT CHARGE 20604 CDM 761 RC facility both 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price 20604 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT CHARGE 20604 CDM 761 RC facility both 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price 20604 DRAIN/INJ JOINT/BURSA W/US TechFee 206041 CDM 450 RC facility both 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price 20604 DRAIN/INJ JOINT/BURSA W/US TechFee 206041 CDM 450 RC facility both 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price "20604 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); ProFee" 206042 CDM 982 RC 20604 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price "20604 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); ProFee" 206042 CDM 982 RC 20604 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price DRN/INJ INTER JT/BRSA W/O US 206051 CDM 521 RC 20605 HCPCS facility both 600 600 Gross Charge Type: NIHD_RHC_Price DRN/INJ INTER JT/BRSA W/O US 206051 CDM 521 RC 20605 HCPCS facility both 218 218 Gross Charge Type: NIHD_Clinic_Price XR Joint/Bursa Intmd Arthr/Asp/Inj Left 2060510 CDM 761 RC facility both TCLT 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Intmd Arthr/Asp/Inj Left 2060510 CDM 761 RC facility both TCLT 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Intmd Arthr/Asp/Inj Left - Report 2060511 CDM 982 RC 20605 HCPCS facility both 26LT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Intmd Arthr/Asp/Inj Left - Report 2060511 CDM 982 RC 20605 HCPCS facility both 26LT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Intmd Arthr/Asp/Inj Right 2060512 CDM 761 RC facility both TCRT 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Intmd Arthr/Asp/Inj Right 2060512 CDM 761 RC facility both TCRT 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Intmd Arthr/Asp/Inj Right - Report 2060513 CDM 982 RC 20605 HCPCS facility both 26RT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Intmd Arthr/Asp/Inj Right - Report 2060513 CDM 982 RC 20605 HCPCS facility both 26RT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US TechFee 206052 CDM 450 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US TechFee 206052 CDM 450 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price "20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROM ProFee" 206053 CDM 982 RC 20605 HCPCS facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price "20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROM ProFee" 206053 CDM 982 RC 20605 HCPCS facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 20605 ARTHROCINTMED JNT CHARGE 206055 CDM 761 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price 20605 ARTHROCINTMED JNT CHARGE 206055 CDM 761 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Elbow Left 206056 CDM 761 RC facility both TCLT 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Elbow Left 206056 CDM 761 RC facility both TCLT 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Elbow Left - Report 206057 CDM 982 RC 20605 HCPCS facility both 26LT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Elbow Left - Report 206057 CDM 982 RC 20605 HCPCS facility both 26LT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Elbow Right 206058 CDM 761 RC facility both TCRT 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Elbow Right 206058 CDM 761 RC facility both TCRT 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Elbow Right - Report 206059 CDM 982 RC 20605 HCPCS facility both 26RT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Elbow Right - Report 206059 CDM 982 RC 20605 HCPCS facility both 26RT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 20606 ARTHROCENTESIS W US GUIDANCE CHARGE 20606 CDM 761 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 20606 ARTHROCENTESIS W US GUIDANCE CHARGE 20606 CDM 761 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 20606 ARTHROCENTESIS W US GUIDANCE 206061 CDM 450 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 20606 ARTHROCENTESIS W US GUIDANCE 206061 CDM 450 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price "20606 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROM ProFee" 206062 CDM 982 RC 20606 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price "20606 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROM ProFee" 206062 CDM 982 RC 20606 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price "20610 Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound guidance" 206101 CDM 521 RC 20610 HCPCS facility both 698 698 Gross Charge Type: NIHD_RHC_Price "20610 Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound guidance" 206101 CDM 521 RC 20610 HCPCS facility both 254 254 Gross Charge Type: NIHD_Clinic_Price US Joint/Bursa Up Maj Arth/Asp/Inj Left - Report 2061010 CDM 982 RC 20610 HCPCS facility both 26LT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price US Joint/Bursa Up Maj Arth/Asp/Inj Left - Report 2061010 CDM 982 RC 20610 HCPCS facility both 26LT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price US Joint/Bursa Up Maj Arth/Asp/Inj Right 2061011 CDM 761 RC facility both TCRT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price US Joint/Bursa Up Maj Arth/Asp/Inj Right 2061011 CDM 761 RC facility both TCRT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price US Joint/Bursa Up Maj Arth/Asp/Inj Right - Report 2061012 CDM 982 RC 20610 HCPCS facility both 26RT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price US Joint/Bursa Up Maj Arth/Asp/Inj Right - Report 2061012 CDM 982 RC 20610 HCPCS facility both 26RT 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Major Arthr/Asp/Inj Left 2061013 CDM 761 RC facility both TCLT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Major Arthr/Asp/Inj Left 2061013 CDM 761 RC facility both TCLT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Major Arthr/Asp/Inj Left - Report 2061014 CDM 982 RC 20610 HCPCS facility both 26LT 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Major Arthr/Asp/Inj Left - Report 2061014 CDM 982 RC 20610 HCPCS facility both 26LT 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Major Arthr/Asp/Inj Right 2061015 CDM 761 RC facility both TCRT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Major Arthr/Asp/Inj Right 2061015 CDM 761 RC facility both TCRT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Major Arthr/Asp/Inj Right - Report 2061016 CDM 982 RC 20610 HCPCS facility both 26RT 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint/Bursa Major Arthr/Asp/Inj Right - Report 2061016 CDM 982 RC 20610 HCPCS facility both 26RT 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price 20610 XR Joint/Bursa Major Arthr/Asp/Inj Unilateral 2061017 CDM 761 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 20610 XR Joint/Bursa Major Arthr/Asp/Inj Unilateral 2061017 CDM 761 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee 206102 CDM 450 RC facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee 206102 CDM 450 RC facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price "20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, ProFee" 206103 CDM 982 RC 20610 HCPCS facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price "20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, ProFee" 206103 CDM 982 RC 20610 HCPCS facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price CT Joint/Bursa Major Arthr/Asp/Inj Left 206105 CDM 761 RC facility both TCLT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price CT Joint/Bursa Major Arthr/Asp/Inj Left 206105 CDM 761 RC facility both TCLT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price CT Joint/Bursa Major Arthr/Asp/Inj Left - Report 206106 CDM 982 RC 20610 HCPCS facility both 26LT 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price CT Joint/Bursa Major Arthr/Asp/Inj Left - Report 206106 CDM 982 RC 20610 HCPCS facility both 26LT 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price CT Joint/Bursa Major Arthr/Asp/Inj Right 206107 CDM 761 RC facility both TCRT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price CT Joint/Bursa Major Arthr/Asp/Inj Right 206107 CDM 761 RC facility both TCRT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price CT Joint/Bursa Major Arthr/Asp/Inj Right - Report 206108 CDM 982 RC 20610 HCPCS facility both 26RT 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price CT Joint/Bursa Major Arthr/Asp/Inj Right - Report 206108 CDM 982 RC 20610 HCPCS facility both 26RT 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price US Joint/Bursa Up Maj Arth/Asp/Inj Left 206109 CDM 761 RC facility both TCLT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price US Joint/Bursa Up Maj Arth/Asp/Inj Left 206109 CDM 761 RC facility both TCLT 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US 206111 CDM 450 RC facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price 20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US 206111 CDM 450 RC facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price "20611 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, ProFee" 206112 CDM 982 RC 20611 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price "20611 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, ProFee" 206112 CDM 982 RC 20611 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price 20612 Aspiration and/or injection of ganglion cyst(s) any location 206121 CDM 521 RC 20612 HCPCS facility both 333 333 Gross Charge Type: NIHD_RHC_Price 20612 Aspiration and/or injection of ganglion cyst(s) any location 206121 CDM 521 RC 20612 HCPCS facility both 266 266 Gross Charge Type: NIHD_Clinic_Price US Aspiration/Inject Ganglion Cyst 206122 CDM 761 RC facility both TC 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price US Aspiration/Inject Ganglion Cyst 206122 CDM 761 RC facility both TC 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price US Aspiration/Inject Ganglion Cyst - Report 206123 CDM 972 RC 20612 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price US Aspiration/Inject Ganglion Cyst - Report 206123 CDM 972 RC 20612 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 20612 US Aspiration/Inject Ganglion Cyst 206124 CDM 761 RC facility both TC 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price 20612 US Aspiration/Inject Ganglion Cyst 206124 CDM 761 RC facility both TC 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price 20612 US Aspiration/Inject Ganglion Cyst PROFEE 206125 CDM 972 RC 20612 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 20612 US Aspiration/Inject Ganglion Cyst PROFEE 206125 CDM 972 RC 20612 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price "20650 Insertion of wire or pin with application of skeletal traction, including removal" 20650 CDM 521 RC 20650 HCPCS facility both 716 716 Gross Charge Type: NIHD_RHC_Price "20650 Insertion of wire or pin with application of skeletal traction, including removal" 20650 CDM 521 RC 20650 HCPCS facility both 750 750 Gross Charge Type: NIHD_Clinic_Price "20670 Removal of implant; superficial (buried wire, pin or rod)" 206701 CDM 521 RC 20670 HCPCS facility both 1590 1590 Gross Charge Type: NIHD_Clinic_Price "20670 REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE) ProFee" 206702 CDM 982 RC 20670 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price "20670 REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE) ProFee" 206702 CDM 982 RC 20670 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price "20680 REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE) ProFee" 20680 CDM 982 RC 20680 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "20680 REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE) ProFee" 20680 CDM 982 RC 20680 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "20690 APPLICATION OF A UNIPLANE (PINS OR WIRES IN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SY ProFee" 20690 CDM 982 RC 20690 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "20690 APPLICATION OF A UNIPLANE (PINS OR WIRES IN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SY ProFee" 20690 CDM 982 RC 20690 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "20692 APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN 1 PLANE), UNILATERAL, EXTERNAL ProFee" 20692 CDM 982 RC 20692 HCPCS facility both 2372 2372 Gross Charge Type: NIHD_Hosp_Profee_Price "20692 APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN 1 PLANE), UNILATERAL, EXTERNAL ProFee" 20692 CDM 982 RC 20692 HCPCS facility both 2372 2372 Gross Charge Type: NIHD_Hosp_Profee_Price "20693 ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, NEW PIN[S ProFee" 20693 CDM 982 RC 20693 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "20693 ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, NEW PIN[S ProFee" 20693 CDM 982 RC 20693 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "20694 REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM ProFee" 20694 CDM 982 RC 20694 HCPCS facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price "20694 REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM ProFee" 20694 CDM 982 RC 20694 HCPCS facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price "20900 BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON) ProFee" 20900 CDM 982 RC 20900 HCPCS facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "20900 BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON) ProFee" 20900 CDM 982 RC 20900 HCPCS facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "20950 MONITORING OF INTERSTITIAL FLUID PRESSURE (INCLUDES INSERTION OF DEVICE, EG, WICK CATH ProFee" 20950 CDM 982 RC 20950 HCPCS facility both 278 278 Gross Charge Type: NIHD_Hosp_Profee_Price "20950 MONITORING OF INTERSTITIAL FLUID PRESSURE (INCLUDES INSERTION OF DEVICE, EG, WICK CATH ProFee" 20950 CDM 982 RC 20950 HCPCS facility both 278 278 Gross Charge Type: NIHD_Hosp_Profee_Price "20985 COMPUTER-ASSISTED SURGICAL NAVIGATIONAL PROCEDURE FOR MUSCULOSKELETAL PROCEDURES, IMAG ProFee" 20985 CDM 982 RC 20985 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price "20985 COMPUTER-ASSISTED SURGICAL NAVIGATIONAL PROCEDURE FOR MUSCULOSKELETAL PROCEDURES, IMAG ProFee" 20985 CDM 982 RC 20985 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 20999 IMS-dry needling 20999 CDM 521 RC 20999 HCPCS facility both 81 81 Gross Charge Type: NIHD_RHC_Price 20999 IMS-dry needling 20999 CDM 521 RC 20999 HCPCS facility both 81 81 Gross Charge Type: NIHD_Clinic_Price "21011 Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm" 210111 CDM 521 RC 21011 HCPCS facility both 476 476 Gross Charge Type: NIHD_Clinic_Price "21011 EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM ProFee" 210112 CDM 982 RC 21011 HCPCS facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price "21011 EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM ProFee" 210112 CDM 982 RC 21011 HCPCS facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price "21012 Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater" 210121 CDM 521 RC 21012 HCPCS facility both 617 617 Gross Charge Type: NIHD_Clinic_Price "21012 EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER ProFee" 210122 CDM 982 RC 21012 HCPCS facility both 617 617 Gross Charge Type: NIHD_Hosp_Profee_Price "21012 EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER ProFee" 210122 CDM 982 RC 21012 HCPCS facility both 617 617 Gross Charge Type: NIHD_Hosp_Profee_Price 21110 APPL INTERDENTAL FIX DEV CONDITIONS OTHER THAN FRAC ProFee 21110 CDM 21110 HCPCS facility both 1146 1146 Gross Charge Type: NIHD_Hosp_Profee_Price 21110 APPL INTERDENTAL FIX DEV CONDITIONS OTHER THAN FRAC ProFee 21110 CDM 21110 HCPCS facility both 1146 1146 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: ICU 2120844 CDM 200 RC facility both 7297 7297 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: ICU 2120844 CDM 200 RC facility both 7297 7297 Gross Charge Type: NIHD_Hosp_Profee_Price 21315 - Nasal Bone Fx w/o Stabilization 213151 CDM 450 RC facility both 3145 3145 Gross Charge Type: NIHD_Hosp_Profee_Price 21315 - Nasal Bone Fx w/o Stabilization 213151 CDM 450 RC facility both 3145 3145 Gross Charge Type: NIHD_Hosp_Profee_Price 21315 CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION ProFee 213152 CDM 982 RC 21315 HCPCS facility both 887 887 Gross Charge Type: NIHD_Hosp_Profee_Price 21315 CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION ProFee 213152 CDM 982 RC 21315 HCPCS facility both 887 887 Gross Charge Type: NIHD_Hosp_Profee_Price 21480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ TechFee 214801 CDM 450 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 21480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ TechFee 214801 CDM 450 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 21480 CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT ProFee 214802 CDM 982 RC 21480 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 21480 CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT ProFee 214802 CDM 982 RC 21480 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "21501 I & D deep abscess/hematoma, soft tissue/neck/thorax" 21501 CDM 982 RC 21501 HCPCS facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price "21501 I & D deep abscess/hematoma, soft tissue/neck/thorax" 21501 CDM 982 RC 21501 HCPCS facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price "21550 Biopsy, soft tissue of neck or thorax" 215501 CDM 521 RC 21550 HCPCS facility both 557 557 Gross Charge Type: NIHD_RHC_Price "21550 Biopsy, soft tissue of neck or thorax" 215501 CDM 521 RC 21550 HCPCS facility both 979 979 Gross Charge Type: NIHD_Clinic_Price CT Biopsy Neck or Chest 215502 CDM 320 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Neck or Chest 215502 CDM 320 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Neck or Chest - Report 215503 CDM 982 RC 21550 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Neck or Chest - Report 215503 CDM 982 RC 21550 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Soft Tissue Neck/Thorax 215504 CDM 761 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Soft Tissue Neck/Thorax 215504 CDM 761 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Soft Tissue Neck/Thorax - Report 215505 CDM 982 RC 21550 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Soft Tissue Neck/Thorax - Report 215505 CDM 982 RC 21550 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price "21552 Excision, tumor, soft tissue of neck or anterior thorax, subcu, 3cm/>" 21552 CDM 982 RC 21552 HCPCS facility both 1349 1349 Gross Charge Type: NIHD_Hosp_Profee_Price "21552 Excision, tumor, soft tissue of neck or anterior thorax, subcu, 3cm/>" 21552 CDM 982 RC 21552 HCPCS facility both 1349 1349 Gross Charge Type: NIHD_Hosp_Profee_Price "21554 EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR ProFee" 21554 CDM 982 RC 21554 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "21554 EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR ProFee" 21554 CDM 982 RC 21554 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm" 21555 CDM 521 RC 21555 HCPCS facility both 1876 1876 Gross Charge Type: NIHD_RHC_Price "21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm" 21555 CDM 521 RC 21555 HCPCS facility both 1395 1395 Gross Charge Type: NIHD_Clinic_Price 21601 ASST REMOVAL OF CHEST WALL LES 21601 CDM 982 RC 21601 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 21601 ASST REMOVAL OF CHEST WALL LES 21601 CDM 982 RC 21601 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 21602 ASST REVISION OF CHEST WALL 21602 CDM 982 RC 21602 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price 21602 ASST REVISION OF CHEST WALL 21602 CDM 982 RC 21602 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCK DISTAL FIBULA PLT, SS LT, 4H" 2183781 CDM 278 RC facility both 1611 1611 Gross Charge Type: NIHD_Hosp_Profee_Price "LOCK DISTAL FIBULA PLT, SS LT, 4H" 2183781 CDM 278 RC facility both 1611 1611 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT KNEE UNIVERSAL 16 INCH 2189933 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT KNEE UNIVERSAL 16 INCH 2189933 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER WOVEN FILIFORM STRAIGHT 5FR 12. 219051 CDM 272 RC facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER WOVEN FILIFORM STRAIGHT 5FR 12. 219051 CDM 272 RC facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price "21930 Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm" 21930 CDM 521 RC 21930 HCPCS facility both 936 936 Gross Charge Type: NIHD_RHC_Price "21930 Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm" 21930 CDM 521 RC 21930 HCPCS facility both 1813 1813 Gross Charge Type: NIHD_Clinic_Price "21931 Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater" 219311 CDM 521 RC 21931 HCPCS facility both 936 936 Gross Charge Type: NIHD_Clinic_Price "21931 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 219312 CDM 982 RC 21931 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "21931 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 219312 CDM 982 RC 21931 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON TORIC LENS 12.0 21955500 CDM 276 RC facility both 1205 1205 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON TORIC LENS 12.0 21955500 CDM 276 RC facility both 1205 1205 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON TORIC LENS CNWOT4 10.5 21955507 CDM 276 RC facility both 1205 1205 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON TORIC LENS CNWOT4 10.5 21955507 CDM 276 RC facility both 1205 1205 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 10.0 2195799 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 10.0 2195799 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 10.5 2195800 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 10.5 2195800 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 11.5 2195801 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 11.5 2195801 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL SYMMETRIC CONE AUGMENT SZ B 2200620 CDM 278 RC facility both 19861 19861 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL SYMMETRIC CONE AUGMENT SZ B 2200620 CDM 278 RC facility both 19861 19861 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL AUGMENT HALF BLOCK #3 10MM 2200621 CDM 278 RC facility both 5009 5009 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL AUGMENT HALF BLOCK #3 10MM 2200621 CDM 278 RC facility both 5009 5009 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER 5515-F-201 2200622 CDM 278 RC facility both 13636 13636 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER 5515-F-201 2200622 CDM 278 RC facility both 13636 13636 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 2.7MM BROAD LOCKING STRAIGHT PLATE 8 HOLE 2200650 CDM 278 RC facility both 1821 1821 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 2.7MM BROAD LOCKING STRAIGHT PLATE 8 HOLE 2200650 CDM 278 RC facility both 1821 1821 Gross Charge Type: NIHD_Hosp_Profee_Price Precision Thin Saw Blade 9.0 x 0.38 x25.0 2207809 CDM 272 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price Precision Thin Saw Blade 9.0 x 0.38 x25.0 2207809 CDM 272 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER WOVEN FILIFORM SPIRAL 5FR 12.5 221051 CDM 272 RC facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER WOVEN FILIFORM SPIRAL 5FR 12.5 221051 CDM 272 RC facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7mm Non-Locking Screws 28mm 2211940 CDM 278 RC facility both 248 248 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7mm Non-Locking Screws 28mm 2211940 CDM 278 RC facility both 248 248 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7mm Locking Screws 20mm 2211941 CDM 278 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7mm Locking Screws 20mm 2211941 CDM 278 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7mm Locking Screws 24mm 2211942 CDM 278 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7mm Locking Screws 24mm 2211942 CDM 278 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price Drill Bit AO 2.0mm x 135mm Scaled 2211944 CDM 272 RC facility both 387 387 Gross Charge Type: NIHD_Hosp_Profee_Price Drill Bit AO 2.0mm x 135mm Scaled 2211944 CDM 272 RC facility both 387 387 Gross Charge Type: NIHD_Hosp_Profee_Price baclofen 10 mg Tab [INYO] 2212 CDM 00904-6475-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB baclofen 10 mg Tab [INYO] 2212 CDM 00172-4096-60 NDC facility both 1 EA 14.83 14.83 Gross Charge Type: Pharmacy | NDC EA = 1 TAB HIP STEM INSIGNIA STANDARD OFFSET SZE 4 2217877 CDM 278 RC facility both 22060 22060 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 4 2217877 CDM 278 RC facility both 22060 22060 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 6 2217878 CDM 278 RC facility both 22060 22060 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 6 2217878 CDM 278 RC facility both 22060 22060 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36D 2217879 CDM 278 RC facility both 8539 8539 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36D 2217879 CDM 278 RC facility both 8539 8539 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM ACCOLADE C V40 SZ 3 X 35 X131MM 2217920 CDM 278 RC facility both 13528 13528 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM ACCOLADE C V40 SZ 3 X 35 X131MM 2217920 CDM 278 RC facility both 13528 13528 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM ACCOLADE C V40 SZ 4 X 35 X137MM 2217950 CDM 278 RC facility both 16234 16234 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM ACCOLADE C V40 SZ 4 X 35 X137MM 2217950 CDM 278 RC facility both 16234 16234 Gross Charge Type: NIHD_Hosp_Profee_Price "X-Act ROM Elbow Brace, Left" 2221812 CDM 274 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price "X-Act ROM Elbow Brace, Left" 2221812 CDM 274 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price XI DAVINCI PERMANENT CAUTERY HOOK 2223823 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price XI DAVINCI PERMANENT CAUTERY HOOK 2223823 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price Knee Support med 2223872 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Knee Support med 2223872 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Knee Support XL 2223873 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Knee Support XL 2223873 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price "22310 CLOSED TREATMENT OF VERTEBRAL BODY FRACTURE(S), WITHOUT MANIPULATION, REQUIRING AND IN ProFee" 22310 CDM 982 RC 22310 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "22310 CLOSED TREATMENT OF VERTEBRAL BODY FRACTURE(S), WITHOUT MANIPULATION, REQUIRING AND IN ProFee" 22310 CDM 982 RC 22310 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "22310 Closed tx of vertebral body fracture(s), w/o manip, requiring and including casting or bracing" 223101 CDM 521 RC 22310 HCPCS facility both 477 477 Gross Charge Type: NIHD_RHC_Price "22310 Closed tx of vertebral body fracture(s), w/o manip, requiring and including casting or bracing" 223101 CDM 521 RC 22310 HCPCS facility both 477 477 Gross Charge Type: NIHD_Clinic_Price XR Vertebroplasty Cervicothoracic 225101 CDM 982 RC facility both 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price XR Vertebroplasty Cervicothoracic 225101 CDM 982 RC facility both 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price XR Vertebroplasty Cervicothoracic - Report 225102 CDM 972 RC 22510 HCPCS facility both 26 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price XR Vertebroplasty Cervicothoracic - Report 225102 CDM 972 RC 22510 HCPCS facility both 26 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price XR Vertebroplasty Lumbosacral 225111 CDM 320 RC facility both TC 4682 4682 Gross Charge Type: NIHD_Hosp_Profee_Price XR Vertebroplasty Lumbosacral 225111 CDM 320 RC facility both TC 4682 4682 Gross Charge Type: NIHD_Hosp_Profee_Price XR Vertebroplasty Lumbosacral - Report 225112 CDM 982 RC 22511 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price XR Vertebroplasty Lumbosacral - Report 225112 CDM 982 RC 22511 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price zzNIHD XR VERTEBROPLASTY LUMBAR EA ADDL 225121 CDM facility both TC 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price zzNIHD XR VERTEBROPLASTY LUMBAR EA ADDL 225121 CDM facility both TC 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR VERTEBROPLASTY THORACIC EA ADDL 225122 CDM 330 RC facility both TC 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR VERTEBROPLASTY THORACIC EA ADDL 225122 CDM 330 RC facility both TC 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR VERTEBROPLASTY LUMBAR EA ADDL 225123 CDM 330 RC facility both TC 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR VERTEBROPLASTY LUMBAR EA ADDL 225123 CDM 330 RC facility both TC 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price VAPR WEDGE ELECTRODE(INTEGRATED) 2272030 CDM 272 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price VAPR WEDGE ELECTRODE(INTEGRATED) 2272030 CDM 272 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL FLEX BIT HIP 35MM - DEPUY 2274355 CDM 272 RC facility both 3686 3686 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL FLEX BIT HIP 35MM - DEPUY 2274355 CDM 272 RC facility both 3686 3686 Gross Charge Type: NIHD_Hosp_Profee_Price Ureteral Balloon straight tip Cath 2276059 CDM 272 RC facility both 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price Ureteral Balloon straight tip Cath 2276059 CDM 272 RC facility both 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy SM/MED 2276115 CDM 274 RC L0650 HCPCS facility both 136 136 Gross Charge Type: NIHD_RHC_Price Back Brace DonJoy SM/MED 2276115 CDM 274 RC L0650 HCPCS facility both 136 136 Gross Charge Type: NIHD_Clinic_Price Back Brace DonJoy SM/MED 2276115 CDM 274 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy SM/MED 2276115 CDM 274 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy L/XL 2276117 CDM 274 RC L0650 HCPCS facility both 507 507 Gross Charge Type: NIHD_RHC_Price Back Brace DonJoy L/XL 2276117 CDM 274 RC L0650 HCPCS facility both 507 507 Gross Charge Type: NIHD_Clinic_Price Back Brace DonJoy L/XL 2276117 CDM 274 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy L/XL 2276117 CDM 274 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy Large 2276118 CDM 274 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy Large 2276118 CDM 274 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy XL 2276121 CDM 274 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy XL 2276121 CDM 274 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy XXL 2276122 CDM 274 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Back Brace DonJoy XXL 2276122 CDM 274 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Snap Cartridge 125mmHg w/Reset US 2280948 CDM 271 RC facility both 356 356 Gross Charge Type: NIHD_RHC_Price Snap Cartridge 125mmHg w/Reset US 2280948 CDM 271 RC facility both 356 356 Gross Charge Type: NIHD_Clinic_Price Snap Cartridge 125mmHg w/Reset US 2280948 CDM 271 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price Snap Cartridge 125mmHg w/Reset US 2280948 CDM 271 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS FIBERTAK 1.8MM #2 SUTURE 2284064 CDM 278 RC facility both 1260 1260 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS FIBERTAK 1.8MM #2 SUTURE 2284064 CDM 278 RC facility both 1260 1260 Gross Charge Type: NIHD_Hosp_Profee_Price PERCUTNEOUS INSERTION KIT 1.8 ANCHOR 2284065 CDM 278 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price PERCUTNEOUS INSERTION KIT 1.8 ANCHOR 2284065 CDM 278 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price "22901 Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); 5 cm or greate" 229011 CDM 521 RC 22901 HCPCS facility both 1324 1324 Gross Charge Type: NIHD_Clinic_Price "22901 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM O ProFee" 229012 CDM 982 RC 22901 HCPCS facility both 1324 1324 Gross Charge Type: NIHD_Hosp_Profee_Price "22901 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM O ProFee" 229012 CDM 982 RC 22901 HCPCS facility both 1324 1324 Gross Charge Type: NIHD_Hosp_Profee_Price "22902 Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm" 229021 CDM 521 RC 22902 HCPCS facility both 1652 1652 Gross Charge Type: NIHD_Clinic_Price "22902 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LESS THAN 3 CM ProFee" 229022 CDM 982 RC 22902 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "22902 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LESS THAN 3 CM ProFee" 229022 CDM 982 RC 22902 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "22903 Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater" 229031 CDM 521 RC 22903 HCPCS facility both 799 799 Gross Charge Type: NIHD_Clinic_Price "22903 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 229032 CDM 982 RC 22903 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price "22903 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 229032 CDM 982 RC 22903 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price 22904 ASST RAD RESECT ABD TUMOR <5 22904 CDM 982 RC 22904 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price 22904 ASST RAD RESECT ABD TUMOR <5 22904 CDM 982 RC 22904 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price Broad Band Suture tape with needle 2293875 CDM 272 RC facility both 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price Broad Band Suture tape with needle 2293875 CDM 272 RC facility both 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 0.062 X 3 IN 2300094 CDM 272 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 0.062 X 3 IN 2300094 CDM 272 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM ACCOLADE C V40 SZ 7 X 40 X158MM 2300119 CDM 278 RC facility both 15498 15498 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM ACCOLADE C V40 SZ 7 X 40 X158MM 2300119 CDM 278 RC facility both 15498 15498 Gross Charge Type: NIHD_Hosp_Profee_Price SURGICEL ZIP 4 SKIN CLOSURE DEVICE 2300151 CDM 272 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price SURGICEL ZIP 4 SKIN CLOSURE DEVICE 2300151 CDM 272 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price ZIP 8 SURGICAL SKIN CLOSURE DEVICE 2300152 CDM 272 RC facility both 1800 1800 Gross Charge Type: NIHD_Hosp_Profee_Price ZIP 8 SURGICAL SKIN CLOSURE DEVICE 2300152 CDM 272 RC facility both 1800 1800 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE SILK TIES 4-0 30 INCHES 2300155 CDM 272 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE SILK TIES 4-0 30 INCHES 2300155 CDM 272 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price SURGICLIP CLIP APPLIER 9.0 SMALL 2300156 CDM 272 RC facility both 620 620 Gross Charge Type: NIHD_Hosp_Profee_Price SURGICLIP CLIP APPLIER 9.0 SMALL 2300156 CDM 272 RC facility both 620 620 Gross Charge Type: NIHD_Hosp_Profee_Price BIODFENCE G3 PLACENTAL TISSUE MEMBRANE 4.0 X 8.0 CM 2300200 CDM 272 RC facility both 13104 13104 Gross Charge Type: NIHD_Hosp_Profee_Price BIODFENCE G3 PLACENTAL TISSUE MEMBRANE 4.0 X 8.0 CM 2300200 CDM 272 RC facility both 13104 13104 Gross Charge Type: NIHD_Hosp_Profee_Price UNIVERSAL DAVINCI CANNULA SEAL 2300205 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price UNIVERSAL DAVINCI CANNULA SEAL 2300205 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER MALECOT SIZE 30 FR 2300206 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER MALECOT SIZE 30 FR 2300206 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER MALECOT SIZE 32 FR 2300207 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER MALECOT SIZE 32 FR 2300207 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER MALECOT SIZE 34 FR 2300208 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER MALECOT SIZE 34 FR 2300208 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price ETHICON POWERED EEA STAPLER SIZE 29 2300209 CDM 278 RC facility both 1056 1056 Gross Charge Type: NIHD_Hosp_Profee_Price ETHICON POWERED EEA STAPLER SIZE 29 2300209 CDM 278 RC facility both 1056 1056 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 14.0 OPTIC LENS 2300225 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 14.0 OPTIC LENS 2300225 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price UROLOGY ELECTRODE QUICK FIRE 12 DEG LARGE LOOP 2300253 CDM 272 RC facility both 897 897 Gross Charge Type: NIHD_Hosp_Profee_Price UROLOGY ELECTRODE QUICK FIRE 12 DEG LARGE LOOP 2300253 CDM 272 RC facility both 897 897 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR VITRECTOMY PROBE 23 GAUGE (ALCON) 2300300 CDM 272 RC facility both 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price ANTERIOR VITRECTOMY PROBE 23 GAUGE (ALCON) 2300300 CDM 272 RC facility both 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price "SUTURE MONOCRYL 4-0 PS-2 27""" 2300426 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price "SUTURE MONOCRYL 4-0 PS-2 27""" 2300426 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAPPING CROSSPIN 1.2X12MM 2300620 CDM 278 RC facility both 236 236 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAPPING CROSSPIN 1.2X12MM 2300620 CDM 278 RC facility both 236 236 Gross Charge Type: NIHD_Hosp_Profee_Price 0 PDS LIGATURE ENDOLOOPS 2300621 CDM 272 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 0 PDS LIGATURE ENDOLOOPS 2300621 CDM 272 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOCLIP 10MM CLIP APPLIER 2300622 CDM 272 RC facility both 1113 1113 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOCLIP 10MM CLIP APPLIER 2300622 CDM 272 RC facility both 1113 1113 Gross Charge Type: NIHD_Hosp_Profee_Price 5 FR OPEN ENDED CATHETER (POLLACK) BOSTON SCIENTIFIC 2300700 CDM 272 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price 5 FR OPEN ENDED CATHETER (POLLACK) BOSTON SCIENTIFIC 2300700 CDM 272 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price INTRODUCER BERCI-CYSTIC DUCT SET 2300701 CDM 272 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price INTRODUCER BERCI-CYSTIC DUCT SET 2300701 CDM 272 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTER-200 3-WAY MULTIPURPOSE FOR COMMON DUCT EXPLORATION 2300702 CDM 272 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTER-200 3-WAY MULTIPURPOSE FOR COMMON DUCT EXPLORATION 2300702 CDM 272 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price STONE EXTRACTOR NITINOL TIPLESS FOR COMMONDUCT BILE 2300703 CDM 272 RC facility both 822 822 Gross Charge Type: NIHD_Hosp_Profee_Price STONE EXTRACTOR NITINOL TIPLESS FOR COMMONDUCT BILE 2300703 CDM 272 RC facility both 822 822 Gross Charge Type: NIHD_Hosp_Profee_Price BALLO0N CATHETER 5.0 fr 40CM LONG FOR COMMONDUCT EXPLORATION 2300704 CDM 278 RC facility both 1244 1244 Gross Charge Type: NIHD_Hosp_Profee_Price BALLO0N CATHETER 5.0 fr 40CM LONG FOR COMMONDUCT EXPLORATION 2300704 CDM 278 RC facility both 1244 1244 Gross Charge Type: NIHD_Hosp_Profee_Price BILIARY WIRE .035IN X 145CM LONG GUIDE FOR COMMONBILE DUCT EXPLORATION 2300705 CDM 278 RC facility both 249 249 Gross Charge Type: NIHD_Hosp_Profee_Price BILIARY WIRE .035IN X 145CM LONG GUIDE FOR COMMONBILE DUCT EXPLORATION 2300705 CDM 278 RC facility both 249 249 Gross Charge Type: NIHD_Hosp_Profee_Price COMPLIANCE ENDO KITS 2300753 CDM 272 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price COMPLIANCE ENDO KITS 2300753 CDM 272 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price SNARE ROTATABLE 13 MM (BOSTON SCIENTIFIC) 2300754 CDM 272 RC facility both 60 60 Gross Charge Type: NIHD_Hosp_Profee_Price SNARE ROTATABLE 13 MM (BOSTON SCIENTIFIC) 2300754 CDM 272 RC facility both 60 60 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS COARSE 4-10 MM BONE CHIPS 2300762 CDM 272 RC facility both 465 465 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS COARSE 4-10 MM BONE CHIPS 2300762 CDM 272 RC facility both 465 465 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER QUANTA HOLIUM 200 MICRON (NEW LASER) 2300766 CDM 272 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER QUANTA HOLIUM 200 MICRON (NEW LASER) 2300766 CDM 272 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON TIBIAL COMPONENT SIZE 8 2300767 CDM 278 RC facility both 15267 15267 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON TIBIAL COMPONENT SIZE 8 2300767 CDM 278 RC facility both 15267 15267 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS-SZ 8 2300768 CDM 278 RC facility both 11346 11346 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS-SZ 8 2300768 CDM 278 RC facility both 11346 11346 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 8 MM CANNULA CAP AND OBTURATOR (IAS8-dv) 2300769 CDM 278 RC facility both 315 315 Gross Charge Type: NIHD_Hosp_Profee_Price AIRSEAL 8 MM CANNULA CAP AND OBTURATOR (IAS8-dv) 2300769 CDM 278 RC facility both 315 315 Gross Charge Type: NIHD_Hosp_Profee_Price LASER QUANTA HOLMIUM 272 FIBER MICRON (NEW LASER) 2300770 CDM 272 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price LASER QUANTA HOLMIUM 272 FIBER MICRON (NEW LASER) 2300770 CDM 272 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price LASER QUANTA HOLMIUM 365 MICRON FIBER (NEW LASER) 2300771 CDM 272 RC facility both 855 855 Gross Charge Type: NIHD_Hosp_Profee_Price LASER QUANTA HOLMIUM 365 MICRON FIBER (NEW LASER) 2300771 CDM 272 RC facility both 855 855 Gross Charge Type: NIHD_Hosp_Profee_Price LASER QUANTA HOLMIUM 500 MICRON FIBER (NEW LASER) 2300772 CDM 272 RC facility both 1005 1005 Gross Charge Type: NIHD_Hosp_Profee_Price LASER QUANTA HOLMIUM 500 MICRON FIBER (NEW LASER) 2300772 CDM 272 RC facility both 1005 1005 Gross Charge Type: NIHD_Hosp_Profee_Price LASER QUANTA HOLMIUM 800 MICRON FIBER (NEW LASER) 2300773 CDM 272 RC facility both 1677 1677 Gross Charge Type: NIHD_Hosp_Profee_Price LASER QUANTA HOLMIUM 800 MICRON FIBER (NEW LASER) 2300773 CDM 272 RC facility both 1677 1677 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 14.5 2300801 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 14.5 2300801 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE 2-0 MONODERM QUILL 16 IN 2300802 CDM 272 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE 2-0 MONODERM QUILL 16 IN 2300802 CDM 272 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price PREVENA PLUS 125 THERAPY UNIT 2300809 CDM 271 RC facility both 1230 1230 Gross Charge Type: NIHD_Hosp_Profee_Price PREVENA PLUS 125 THERAPY UNIT 2300809 CDM 271 RC facility both 1230 1230 Gross Charge Type: NIHD_Hosp_Profee_Price Q LARGE BIOPOLAR PLASMA LOOP ELECTRODE 2300851 CDM 272 RC facility both 852 852 Gross Charge Type: NIHD_Hosp_Profee_Price Q LARGE BIOPOLAR PLASMA LOOP ELECTRODE 2300851 CDM 272 RC facility both 852 852 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS DISTAL CLAVICLE PLATE BUTTON TIGHTROPE 2300900 CDM 278 RC facility both 2580 2580 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS DISTAL CLAVICLE PLATE BUTTON TIGHTROPE 2300900 CDM 278 RC facility both 2580 2580 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL PIN BUTTON 2300901 CDM 272 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL PIN BUTTON 2300901 CDM 272 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON X3 ASYMMETRIC PATELLA SZ A35 10MM 2300902 CDM 278 RC facility both 5334 5334 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON X3 ASYMMETRIC PATELLA SZ A35 10MM 2300902 CDM 278 RC facility both 5334 5334 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHALON UNIVERSAL TIBIAL BASEPLATE SZ 8 2300904 CDM 278 RC facility both 13602 13602 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHALON UNIVERSAL TIBIAL BASEPLATE SZ 8 2300904 CDM 278 RC facility both 13602 13602 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON BEARING INSERT-CS SIZE 8 13MM 2300905 CDM 278 RC facility both 11346 11346 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON BEARING INSERT-CS SIZE 8 13MM 2300905 CDM 278 RC facility both 11346 11346 Gross Charge Type: NIHD_Hosp_Profee_Price SEE SHARP ENHANCED 150MM TROCAR (ROBOTIC) 2300915 CDM 278 RC facility both 135 135 Gross Charge Type: NIHD_Hosp_Profee_Price SEE SHARP ENHANCED 150MM TROCAR (ROBOTIC) 2300915 CDM 278 RC facility both 135 135 Gross Charge Type: NIHD_Hosp_Profee_Price HAND/WRIST LIGAMENT AUGMENTATION REPAIR CONVIENCE KIT 2300925 CDM 272 RC facility both 4485 4485 Gross Charge Type: NIHD_Hosp_Profee_Price HAND/WRIST LIGAMENT AUGMENTATION REPAIR CONVIENCE KIT 2300925 CDM 272 RC facility both 4485 4485 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF IQ PANOPTIX TRIFOCAL IOL 9.5 2300930 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF IQ PANOPTIX TRIFOCAL IOL 9.5 2300930 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price HEMASTATIC HEMO-7 SPRAY 2300941 CDM 250 RC facility both 6023 6023 Gross Charge Type: NIHD_Hosp_Profee_Price HEMASTATIC HEMO-7 SPRAY 2300941 CDM 250 RC facility both 6023 6023 Gross Charge Type: NIHD_Hosp_Profee_Price RESOLUTION 360 CLIPS 2300942 CDM 278 RC facility both 625 625 Gross Charge Type: NIHD_Hosp_Profee_Price RESOLUTION 360 CLIPS 2300942 CDM 278 RC facility both 625 625 Gross Charge Type: NIHD_Hosp_Profee_Price RESOLUTION ULTRA 360 LARGE CLIP 2300943 CDM 278 RC facility both 574 574 Gross Charge Type: NIHD_Hosp_Profee_Price RESOLUTION ULTRA 360 LARGE CLIP 2300943 CDM 278 RC facility both 574 574 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER 18 FR WITH 10CC BALLOON SILICONIZED 2300945 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER 18 FR WITH 10CC BALLOON SILICONIZED 2300945 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price BIO-PREP BONE PREPARATION KIT ( STRYKER) 2300963 CDM 272 RC facility both 1992 1992 Gross Charge Type: NIHD_Hosp_Profee_Price BIO-PREP BONE PREPARATION KIT ( STRYKER) 2300963 CDM 272 RC facility both 1992 1992 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL CANAL PRESSURIZER WITHOUT HUB MED BLUE 2300964 CDM 272 RC facility both 289 289 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL CANAL PRESSURIZER WITHOUT HUB MED BLUE 2300964 CDM 272 RC facility both 289 289 Gross Charge Type: NIHD_Hosp_Profee_Price REVOLUTION CEMENT MIXING SYSTEM WITH MIS FEMORAL BREAKAWAY NOZZEL AND CANAL PRESSURIZER 2300965 CDM 272 RC facility both 285 285 Gross Charge Type: NIHD_Hosp_Profee_Price REVOLUTION CEMENT MIXING SYSTEM WITH MIS FEMORAL BREAKAWAY NOZZEL AND CANAL PRESSURIZER 2300965 CDM 272 RC facility both 285 285 Gross Charge Type: NIHD_Hosp_Profee_Price KUMPE ACCESS CATHETER 5 FRENCH 2300975 CDM 272 RC facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price KUMPE ACCESS CATHETER 5 FRENCH 2300975 CDM 272 RC facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHREX DISTAL THIRD CLAVICLE PLATE 70MM 5 HOLE 2300985 CDM 278 RC facility both 2226 2226 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHREX DISTAL THIRD CLAVICLE PLATE 70MM 5 HOLE 2300985 CDM 278 RC facility both 2226 2226 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CLAVICLE 2.7 X 14MM LOCKING ARTHREX 2300987 CDM 278 RC facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CLAVICLE 2.7 X 14MM LOCKING ARTHREX 2300987 CDM 278 RC facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CLAVICLE LOW PROFILE 2.7 X 16MM ARTHREX 2300988 CDM 278 RC facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CLAVICLE LOW PROFILE 2.7 X 16MM ARTHREX 2300988 CDM 278 RC facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CLAVICLE LOW PROFILE 2.7 X 16MM NONLOCKING ARTHREX 2300989 CDM 278 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CLAVICLE LOW PROFILE 2.7 X 16MM NONLOCKING ARTHREX 2300989 CDM 278 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CLAVICLE LOW PROFILE 3.5 X 14 MM CORTICAL NONLOCKING ARTHREX 2300992 CDM 278 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CLAVICLE LOW PROFILE 3.5 X 14 MM CORTICAL NONLOCKING ARTHREX 2300992 CDM 278 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CLAVICLE LOW PROFILE 3.5 X 16MM CORTICAL NONLOCKING ARTHREX 2300993 CDM 278 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CLAVICLE LOW PROFILE 3.5 X 16MM CORTICAL NONLOCKING ARTHREX 2300993 CDM 278 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VAR ANGLE 1.5 CHONDYLAR 2 HOLE HEAD 6 HOLE SHAFT 2300997 CDM 278 RC facility both 1603 1603 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VAR ANGLE 1.5 CHONDYLAR 2 HOLE HEAD 6 HOLE SHAFT 2300997 CDM 278 RC facility both 1603 1603 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF TAP 1.5 X 10MM CORTEX WITH T4 STARDRIVE RECESS 2300998 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF TAP 1.5 X 10MM CORTEX WITH T4 STARDRIVE RECESS 2300998 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF TAP 1.5 X 14 MM CORTEX WITH T4 STARDRIVE RECESS 2300999 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF TAP 1.5 X 14 MM CORTEX WITH T4 STARDRIVE RECESS 2300999 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF TAP 1.5 X 15 MM CORTEX WITH T4 STARDRIVE RECESS 2301000 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF TAP 1.5 X 15 MM CORTEX WITH T4 STARDRIVE RECESS 2301000 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF TAP 1.5 X 16 MM CORTEX WITH T4 STARDRIVE RECESS 2301001 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF TAP 1.5 X 16 MM CORTEX WITH T4 STARDRIVE RECESS 2301001 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF-TAP VAR ANGLE LOCKING 1.5 X 11 MM WITH T4 STARDRIVE RECESS 2301002 CDM 278 RC facility both 422 422 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF-TAP VAR ANGLE LOCKING 1.5 X 11 MM WITH T4 STARDRIVE RECESS 2301002 CDM 278 RC facility both 422 422 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF-TAP VAR ANGLE LOCKING 1.5 X 13 MM WITH T4 STARDRIVE RECESS 2301003 CDM 278 RC facility both 422 422 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW SELF-TAP VAR ANGLE LOCKING 1.5 X 13 MM WITH T4 STARDRIVE RECESS 2301003 CDM 278 RC facility both 422 422 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 1.1 MM MINI QUICK COUPLING 2301004 CDM 272 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 1.1 MM MINI QUICK COUPLING 2301004 CDM 272 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0 MM MINI QUICK COUPLING 2301005 CDM 272 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0 MM MINI QUICK COUPLING 2301005 CDM 272 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR CLUSTERHOLE SHELL 46MM C 2301010 CDM 278 RC facility both 10641 10641 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR CLUSTERHOLE SHELL 46MM C 2301010 CDM 278 RC facility both 10641 10641 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA HIGH OFFSET SZ 1 X 33.5 X 96MM 2301011 CDM 278 RC facility both 26688 26688 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA HIGH OFFSET SZ 1 X 33.5 X 96MM 2301011 CDM 278 RC facility both 26688 26688 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON TIBIAL BEARING INSERT SZ 3 X 12 MM 2301013 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON TIBIAL BEARING INSERT SZ 3 X 12 MM 2301013 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON TIBIAL BEARING INSERT SZ 3 X 16 MM 2301014 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON TIBIAL BEARING INSERT SZ 3 X 16 MM 2301014 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 16.5 OPTIC LENS 2301015 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 16.5 OPTIC LENS 2301015 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MULTIFOCAL FOLDABLE 16.5 OPTIC LENS 2301016 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MULTIFOCAL FOLDABLE 16.5 OPTIC LENS 2301016 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 10.0 OPTIC LENS 2301017 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 10.0 OPTIC LENS 2301017 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 09.0 2301018 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 09.0 2301018 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM ACCOLADE C SZ 5 X 37 X145MM 2301020 CDM 278 RC facility both 13528 13528 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM ACCOLADE C SZ 5 X 37 X145MM 2301020 CDM 278 RC facility both 13528 13528 Gross Charge Type: NIHD_Hosp_Profee_Price EMG TUBE NIM TRIVANTAGE 6.0 ID 2301021 CDM 272 RC facility both 925 925 Gross Charge Type: NIHD_Hosp_Profee_Price EMG TUBE NIM TRIVANTAGE 6.0 ID 2301021 CDM 272 RC facility both 925 925 Gross Charge Type: NIHD_Hosp_Profee_Price EMG TUBE NIM TRIVANTAGE 7.0 MM ID 2301022 CDM 272 RC facility both 925 925 Gross Charge Type: NIHD_Hosp_Profee_Price EMG TUBE NIM TRIVANTAGE 7.0 MM ID 2301022 CDM 272 RC facility both 925 925 Gross Charge Type: NIHD_Hosp_Profee_Price PROBE 5 PK STD PRASS FL TIP ROHS FOR NIM NEUROTRANSMITTER 2301023 CDM 272 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price PROBE 5 PK STD PRASS FL TIP ROHS FOR NIM NEUROTRANSMITTER 2301023 CDM 272 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price EMG TUBE TRIVANTAGE 6.0 MM REPLACEMENT 2301024 CDM 272 RC facility both 925 925 Gross Charge Type: NIHD_Hosp_Profee_Price EMG TUBE TRIVANTAGE 6.0 MM REPLACEMENT 2301024 CDM 272 RC facility both 925 925 Gross Charge Type: NIHD_Hosp_Profee_Price FOLEY CATHETER SILCONE 18 FR 10ML 2-WAY STRAIGHT 2301025 CDM 272 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price FOLEY CATHETER SILCONE 18 FR 10ML 2-WAY STRAIGHT 2301025 CDM 272 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price BIOPSY RADIAL JAW 2.8 MM BOSTON SCIENTIFIC 2301029 CDM 272 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price BIOPSY RADIAL JAW 2.8 MM BOSTON SCIENTIFIC 2301029 CDM 272 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price BIOPSY FORCEP HOT RADIAL JAW 4 2.8MM 2301030 CDM 278 RC facility both 255 255 Gross Charge Type: NIHD_Hosp_Profee_Price BIOPSY FORCEP HOT RADIAL JAW 4 2.8MM 2301030 CDM 278 RC facility both 255 255 Gross Charge Type: NIHD_Hosp_Profee_Price STENT SOFT PERCUFLEX URETERAL 6 X 22 BOSTON SCIENTIFIC 2301031 CDM 278 RC facility both 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price STENT SOFT PERCUFLEX URETERAL 6 X 22 BOSTON SCIENTIFIC 2301031 CDM 278 RC facility both 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price STENT SOFT PERCUFLEX 6 X 24 BOSTON SCIENTIFIC 2301032 CDM 278 RC facility both 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price STENT SOFT PERCUFLEX 6 X 24 BOSTON SCIENTIFIC 2301032 CDM 278 RC facility both 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price "23030 INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS OR HEMATOMA ProFee" 23030 CDM 982 RC 23030 HCPCS facility both 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price "23030 INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS OR HEMATOMA ProFee" 23030 CDM 982 RC 23030 HCPCS facility both 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price "23040 ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN ProFee" 23040 CDM 982 RC 23040 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "23040 ARTHROTOMY, GLENOHUMERAL JOINT, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN ProFee" 23040 CDM 982 RC 23040 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price QUICKVUE STREP A TEST 2304305 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price QUICKVUE STREP A TEST 2304305 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "23044 ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT, INCLUDING EXPLORATION, DRAINAGE ProFee" 23044 CDM 982 RC 23044 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "23044 ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT, INCLUDING EXPLORATION, DRAINAGE ProFee" 23044 CDM 982 RC 23044 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "23071 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 23071 CDM 982 RC 23071 HCPCS facility both 727 727 Gross Charge Type: NIHD_Hosp_Profee_Price "23071 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 23071 CDM 982 RC 23071 HCPCS facility both 727 727 Gross Charge Type: NIHD_Hosp_Profee_Price "23073 Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greater" 230731 CDM 521 RC 23073 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Clinic_Price "23073 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR ProFee" 230732 CDM 982 RC 23073 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "23073 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR ProFee" 230732 CDM 982 RC 23073 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "23075 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; LESS THAN 3 CM ProFee" 23075 CDM 982 RC 23075 HCPCS facility both 571 571 Gross Charge Type: NIHD_Hosp_Profee_Price "23075 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; LESS THAN 3 CM ProFee" 23075 CDM 982 RC 23075 HCPCS facility both 571 571 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT FINGER STAX SIZE 1 2307943 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price SPLINT FINGER STAX SIZE 1 2307943 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price SPLINT FINGER STAX SIZE 1 2307943 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT FINGER STAX SIZE 1 2307943 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "23107 ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL OF LOO ProFee" 23107 CDM 982 RC 23107 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "23107 ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL OF LOO ProFee" 23107 CDM 982 RC 23107 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral SZ 2 LT 2311121 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral SZ 2 LT 2311121 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 9.5 2313870 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 9.5 2313870 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price HIPSTEM-HIGH OFFSET INSIGNIA SZ 3 36MM LENGTH 2313885 CDM 278 RC facility both 26688 26688 Gross Charge Type: NIHD_Hosp_Profee_Price HIPSTEM-HIGH OFFSET INSIGNIA SZ 3 36MM LENGTH 2313885 CDM 278 RC facility both 26688 26688 Gross Charge Type: NIHD_Hosp_Profee_Price PRESSURE INJECTABLE PICC 1 LUMEN 2320504 CDM 271 RC facility both 279 279 Gross Charge Type: NIHD_Hosp_Profee_Price PRESSURE INJECTABLE PICC 1 LUMEN 2320504 CDM 271 RC facility both 279 279 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 17.0 2330352 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 17.0 2330352 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Hysterosalpingography (HSG) Catheter 5.5Fr x 40cm 2330570 CDM 272 RC C1726 HCPCS facility both 165 165 Gross Charge Type: NIHD_RHC_Price Hysterosalpingography (HSG) Catheter 5.5Fr x 40cm 2330570 CDM 272 RC C1726 HCPCS facility both 165 165 Gross Charge Type: NIHD_Clinic_Price Hysterosalpingography (HSG) Catheter 5.5Fr x 40cm 2330570 CDM 272 RC facility both 165 165 Gross Charge Type: NIHD_Hosp_Profee_Price Hysterosalpingography (HSG) Catheter 5.5Fr x 40cm 2330570 CDM 272 RC facility both 165 165 Gross Charge Type: NIHD_Hosp_Profee_Price "23335 REMOVAL OF PROSTHESIS, INCLUDES DEBRIDEMENT AND SYNOVECTOMY WHEN PERFORMED; HUMERAL AN ProFee" 23335 CDM 975 RC 23335 HCPCS facility both 1903 1903 Gross Charge Type: NIHD_Hosp_Profee_Price "23335 REMOVAL OF PROSTHESIS, INCLUDES DEBRIDEMENT AND SYNOVECTOMY WHEN PERFORMED; HUMERAL AN ProFee" 23335 CDM 975 RC 23335 HCPCS facility both 1903 1903 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Shoulder Right - Report 233501 CDM 972 RC 23350 HCPCS facility both RT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Shoulder Right - Report 233501 CDM 972 RC 23350 HCPCS facility both RT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Shoulder Left - Report 233502 CDM 972 RC 23350 HCPCS facility both LT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Shoulder Left - Report 233502 CDM 972 RC 23350 HCPCS facility both LT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Shoulder Left 233503 CDM 761 RC facility both TCLT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Shoulder Left 233503 CDM 761 RC facility both TCLT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Shoulder Right 233504 CDM 761 RC facility both TCRT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Shoulder Right 233504 CDM 761 RC facility both TCRT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price 23350 XR INJ ARTHROGRAM SHOULDER 233505 CDM 761 RC facility both TC50 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price 23350 XR INJ ARTHROGRAM SHOULDER 233505 CDM 761 RC facility both TC50 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price 23350 XR INJ ARTHROGRAM SHOULDER:PRO 233506 CDM 972 RC 23350 HCPCS facility both 2650 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price 23350 XR INJ ARTHROGRAM SHOULDER:PRO 233506 CDM 972 RC 23350 HCPCS facility both 2650 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price "23405 TENOTOMY, SHOULDER AREA; SINGLE TENDON ProFee" 23405 CDM 975 RC 23405 HCPCS facility both 1090 1090 Gross Charge Type: NIHD_Hosp_Profee_Price "23405 TENOTOMY, SHOULDER AREA; SINGLE TENDON ProFee" 23405 CDM 975 RC 23405 HCPCS facility both 1090 1090 Gross Charge Type: NIHD_Hosp_Profee_Price "23410 REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE ProFee" 23410 CDM 982 RC 23410 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "23410 REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE ProFee" 23410 CDM 982 RC 23410 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price T2 ALPHA TIBIAL NAIL 11X380MM 23411136 CDM 278 RC facility both 4446 4446 Gross Charge Type: NIHD_Hosp_Profee_Price T2 ALPHA TIBIAL NAIL 11X380MM 23411136 CDM 278 RC facility both 4446 4446 Gross Charge Type: NIHD_Hosp_Profee_Price 23430 TENODESIS OF LONG TENDON OF BICEPS ProFee 23430 CDM 982 RC 23430 HCPCS facility both 1548 1548 Gross Charge Type: NIHD_Hosp_Profee_Price 23430 TENODESIS OF LONG TENDON OF BICEPS ProFee 23430 CDM 982 RC 23430 HCPCS facility both 1548 1548 Gross Charge Type: NIHD_Hosp_Profee_Price 23440 RESECTION OR TRANSPLANTATION OF LONG TENDON OF BICEPS ProFee 23440 CDM 982 RC 23440 HCPCS facility both 2382 2382 Gross Charge Type: NIHD_Hosp_Profee_Price 23440 RESECTION OR TRANSPLANTATION OF LONG TENDON OF BICEPS ProFee 23440 CDM 982 RC 23440 HCPCS facility both 2382 2382 Gross Charge Type: NIHD_Hosp_Profee_Price "23466 CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPE MULTI-DIRECTIONAL INSTABILITY ProFee" 23466 CDM 23466 HCPCS facility both 1691 1691 Gross Charge Type: NIHD_Hosp_Profee_Price "23466 CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPE MULTI-DIRECTIONAL INSTABILITY ProFee" 23466 CDM 23466 HCPCS facility both 1691 1691 Gross Charge Type: NIHD_Hosp_Profee_Price "23470 ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY ProFee" 23470 CDM 982 RC 23470 HCPCS facility both 2101 2101 Gross Charge Type: NIHD_Hosp_Profee_Price "23470 ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY ProFee" 23470 CDM 982 RC 23470 HCPCS facility both 2101 2101 Gross Charge Type: NIHD_Hosp_Profee_Price "23472 ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACE ProFee" 23472 CDM 982 RC 23472 HCPCS facility both 2994 2994 Gross Charge Type: NIHD_Hosp_Profee_Price "23472 ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACE ProFee" 23472 CDM 982 RC 23472 HCPCS facility both 2994 2994 Gross Charge Type: NIHD_Hosp_Profee_Price "23474 REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL A ProFee" 23474 CDM 982 RC 23474 HCPCS facility both 3181 3181 Gross Charge Type: NIHD_Hosp_Profee_Price "23474 REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL A ProFee" 23474 CDM 982 RC 23474 HCPCS facility both 3181 3181 Gross Charge Type: NIHD_Hosp_Profee_Price 23500 Closed treatment of clavicular fracture; without manipulation 235001 CDM 521 RC 23500 HCPCS facility both 698 698 Gross Charge Type: NIHD_Clinic_Price 23500 CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION TechFee 235002 CDM 450 RC facility both 1137 1137 Gross Charge Type: NIHD_Hosp_Profee_Price 23500 CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION TechFee 235002 CDM 450 RC facility both 1137 1137 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING DRILL 4.2X380MM 23514236 CDM 278 RC facility both 399 399 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING DRILL 4.2X380MM 23514236 CDM 278 RC facility both 399 399 Gross Charge Type: NIHD_Hosp_Profee_Price "23515 OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 23515 CDM 982 RC 23515 HCPCS facility both 1473 1473 Gross Charge Type: NIHD_Hosp_Profee_Price "23515 OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 23515 CDM 982 RC 23515 HCPCS facility both 1473 1473 Gross Charge Type: NIHD_Hosp_Profee_Price "Cent Venous Catheter, Double Lumen, 7 Fr x 16 cm" 2352334 CDM 278 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price "Cent Venous Catheter, Double Lumen, 7 Fr x 16 cm" 2352334 CDM 278 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price 23525 CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH MANIPULATION ProFee 23525 CDM 982 RC 23525 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price 23525 CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH MANIPULATION ProFee 23525 CDM 982 RC 23525 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price Pericardio Catheter Set 2354309 CDM 272 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price Pericardio Catheter Set 2354309 CDM 272 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price "23550 OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; ProFee" 23550 CDM 975 RC 23550 HCPCS facility both 1002 1002 Gross Charge Type: NIHD_Hosp_Profee_Price "23550 OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; ProFee" 23550 CDM 975 RC 23550 HCPCS facility both 1002 1002 Gross Charge Type: NIHD_Hosp_Profee_Price 23570 Closed treatment of scapular fracture; without manipulation 235701 CDM 521 RC 23570 HCPCS facility both 831 831 Gross Charge Type: NIHD_Clinic_Price 23570 CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION ProFee 235702 CDM 982 RC 23570 HCPCS facility both 483 483 Gross Charge Type: NIHD_Hosp_Profee_Price 23570 CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION ProFee 235702 CDM 982 RC 23570 HCPCS facility both 483 483 Gross Charge Type: NIHD_Hosp_Profee_Price "23585 OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) INCLUDES INTERNAL FIXA ProFee" 23585 CDM 982 RC 23585 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "23585 OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) INCLUDES INTERNAL FIXA ProFee" 23585 CDM 982 RC 23585 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price 23600 Closed treatment of proximal humeral fracture; without manipulation 236001 CDM 521 RC 23600 HCPCS facility both 1064 1064 Gross Charge Type: NIHD_Clinic_Price 23600 CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITHOUT M ProFee 236002 CDM 982 RC 23600 HCPCS facility both 575 575 Gross Charge Type: NIHD_Hosp_Profee_Price 23600 CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITHOUT M ProFee 236002 CDM 982 RC 23600 HCPCS facility both 575 575 Gross Charge Type: NIHD_Hosp_Profee_Price 23605 CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITH MANI ProFee 23605 CDM 982 RC 23605 HCPCS facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price 23605 CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITH MANI ProFee 23605 CDM 982 RC 23605 HCPCS facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING SCREW 5 X 37.5 23605037 CDM 278 RC facility both 531 531 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING SCREW 5 X 37.5 23605037 CDM 278 RC facility both 531 531 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING SCREW 5X40MM 23605040 CDM 278 RC facility both 531 531 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING SCREW 5X40MM 23605040 CDM 278 RC facility both 531 531 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING SCREW 5X42.5MM 23605042 CDM 278 RC facility both 531 531 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING SCREW 5X42.5MM 23605042 CDM 278 RC facility both 531 531 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING SCREW 05X50MM 23605050 CDM 278 RC facility both 531 531 Gross Charge Type: NIHD_Hosp_Profee_Price T2 IMN LOCKING SCREW 05X50MM 23605050 CDM 278 RC facility both 531 531 Gross Charge Type: NIHD_Hosp_Profee_Price "23615 OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLUDES IN ProFee" 23615 CDM 982 RC 23615 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "23615 OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLUDES IN ProFee" 23615 CDM 982 RC 23615 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "23616 OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLUDES IN ProFee" 23616 CDM 982 RC 23616 HCPCS facility both 2558 2558 Gross Charge Type: NIHD_Hosp_Profee_Price "23616 OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLUDES IN ProFee" 23616 CDM 982 RC 23616 HCPCS facility both 2558 2558 Gross Charge Type: NIHD_Hosp_Profee_Price 23620 Closed treatment of greater humeral tuberosity fracture; without manipulation 23620 CDM 521 RC 23620 HCPCS facility both 931 931 Gross Charge Type: NIHD_Clinic_Price "23630 OPEN TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE, INCLUDES INTERNAL FIXATION, WHE ProFee" 23630 CDM 982 RC 23630 HCPCS facility both 1623 1623 Gross Charge Type: NIHD_Hosp_Profee_Price "23630 OPEN TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE, INCLUDES INTERNAL FIXATION, WHE ProFee" 23630 CDM 982 RC 23630 HCPCS facility both 1623 1623 Gross Charge Type: NIHD_Hosp_Profee_Price 23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES TechFee 236501 CDM 450 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES TechFee 236501 CDM 450 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "23650 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; WITHOUT ANESTHESIA ProFee" 236502 CDM 982 RC 23650 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "23650 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; WITHOUT ANESTHESIA ProFee" 236502 CDM 982 RC 23650 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price 23655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES TechFee 236551 CDM 450 RC facility both 2234 2234 Gross Charge Type: NIHD_Hosp_Profee_Price 23655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES TechFee 236551 CDM 450 RC facility both 2234 2234 Gross Charge Type: NIHD_Hosp_Profee_Price "23655 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING ANESTHESIA ProFee" 236552 CDM 982 RC 23655 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price "23655 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING ANESTHESIA ProFee" 236552 CDM 982 RC 23655 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price 23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ TechFee 236651 CDM 450 RC facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price 23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ TechFee 236651 CDM 450 RC facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "23665 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROSITY, ProFee" 236652 CDM 982 RC 23665 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "23665 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER HUMERAL TUBEROSITY, ProFee" 236652 CDM 982 RC 23665 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price 23675 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/ ProFee 23675 CDM 23675 HCPCS facility both 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price 23675 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/ ProFee 23675 CDM 23675 HCPCS facility both 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price 23675 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ TechFee 236751 CDM 450 RC facility both 2087 2087 Gross Charge Type: NIHD_Hosp_Profee_Price 23675 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ TechFee 236751 CDM 450 RC facility both 2087 2087 Gross Charge Type: NIHD_Hosp_Profee_Price "23700 MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPAR ProFee" 23700 CDM 982 RC 23700 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price "23700 MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPAR ProFee" 23700 CDM 982 RC 23700 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price "23929 UNLISTED PROCEDURE, SHOULDER ProFee" 23929 CDM 982 RC 23929 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "23929 UNLISTED PROCEDURE, SHOULDER ProFee" 23929 CDM 982 RC 23929 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "23930 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA ProFee" 23930 CDM 982 RC 23930 HCPCS facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price "23930 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA ProFee" 23930 CDM 982 RC 23930 HCPCS facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price "23931 Incision and drainage, upper arm or elbow area; bursa" 239311 CDM 521 RC 23931 HCPCS facility both 301 301 Gross Charge Type: NIHD_RHC_Price "23931 Incision and drainage, upper arm or elbow area; bursa" 239311 CDM 521 RC 23931 HCPCS facility both 301 301 Gross Charge Type: NIHD_Clinic_Price "23931 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; BURSA ProFee" 239312 CDM 982 RC 23931 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price "23931 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; BURSA ProFee" 239312 CDM 982 RC 23931 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price ZONENAVIGATOR SYSTEM HANDLE 2400000 CDM 271 RC facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price ZONENAVIGATOR SYSTEM HANDLE 2400000 CDM 271 RC facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price PLASMA BUTTON 12-30 INCHES (UROLOGY) 2400123 CDM 278 RC facility both 1800 1800 Gross Charge Type: NIHD_Hosp_Profee_Price PLASMA BUTTON 12-30 INCHES (UROLOGY) 2400123 CDM 278 RC facility both 1800 1800 Gross Charge Type: NIHD_Hosp_Profee_Price INTERNAL NEUROSTIMULATOR BATTERY (STAGE 2) 2400124 CDM 278 RC facility both 44517 44517 Gross Charge Type: NIHD_Hosp_Profee_Price INTERNAL NEUROSTIMULATOR BATTERY (STAGE 2) 2400124 CDM 278 RC facility both 44517 44517 Gross Charge Type: NIHD_Hosp_Profee_Price BLADDER STIMULATOR COMMUNICATION HANDPIECE (STAGE 2) 2400125 CDM 278 RC facility both 6600 6600 Gross Charge Type: NIHD_Hosp_Profee_Price BLADDER STIMULATOR COMMUNICATION HANDPIECE (STAGE 2) 2400125 CDM 278 RC facility both 6600 6600 Gross Charge Type: NIHD_Hosp_Profee_Price EXTERNAL NEUROSTIMULATOR (STAGE 2) 2400126 CDM 270 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price EXTERNAL NEUROSTIMULATOR (STAGE 2) 2400126 CDM 270 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price BLADDER STIMULATOR LEAD KIT 2400127 CDM 278 RC facility both 15777 15777 Gross Charge Type: NIHD_Hosp_Profee_Price BLADDER STIMULATOR LEAD KIT 2400127 CDM 278 RC facility both 15777 15777 Gross Charge Type: NIHD_Hosp_Profee_Price BLADDER STIMULATOR ENVELOPE ( STAGE 2) 2400128 CDM facility both 4485 4485 Gross Charge Type: NIHD_Hosp_Profee_Price BLADDER STIMULATOR ENVELOPE ( STAGE 2) 2400128 CDM facility both 4485 4485 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX CNWTTO 13.5 2400130 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX CNWTTO 13.5 2400130 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AMNIOEFFECT SKIN GRAFT 2.0 X 3.0 (sample only) 2400132 CDM 636 RC facility both 0.01 0.01 Gross Charge Type: NIHD_Hosp_Profee_Price AMNIOEFFECT SKIN GRAFT 2.0 X 3.0 (sample only) 2400132 CDM 636 RC facility both 0.01 0.01 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON PANOPTIX TORIX IOL CNWTT6 21.5 2400140 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON PANOPTIX TORIX IOL CNWTT6 21.5 2400140 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price INTRAOCULAR LENS GLIDE 2400158 CDM 272 RC facility both 519 519 Gross Charge Type: NIHD_Hosp_Profee_Price INTRAOCULAR LENS GLIDE 2400158 CDM 272 RC facility both 519 519 Gross Charge Type: NIHD_Hosp_Profee_Price MALYUGIN RING 2.0-6.25 (EYES CASES) 2400159 CDM 272 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price MALYUGIN RING 2.0-6.25 (EYES CASES) 2400159 CDM 272 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPHERAL NERVE EVALUATION BASIC WIRE TEST KIT 2400199 CDM 278 RC facility both 189 189 Gross Charge Type: NIHD_Hosp_Profee_Price PERIPHERAL NERVE EVALUATION BASIC WIRE TEST KIT 2400199 CDM 278 RC facility both 189 189 Gross Charge Type: NIHD_Hosp_Profee_Price EXTERNAL NEURO STIMULATOR (BLADDER INTERSTIM) 2400200 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price EXTERNAL NEURO STIMULATOR (BLADDER INTERSTIM) 2400200 CDM 278 RC facility both 1386 1386 Gross Charge Type: NIHD_Hosp_Profee_Price SMOKEEVAC FILTERED TUBE SET AIR SEAL 2400205 CDM 272 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price SMOKEEVAC FILTERED TUBE SET AIR SEAL 2400205 CDM 272 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price UROLOGY ELECTRODE QUICK FIRE 12 ULTRA THIN BLADDER LOOP MEDIUM 2400252 CDM 272 RC facility both 897 897 Gross Charge Type: NIHD_Hosp_Profee_Price UROLOGY ELECTRODE QUICK FIRE 12 ULTRA THIN BLADDER LOOP MEDIUM 2400252 CDM 272 RC facility both 897 897 Gross Charge Type: NIHD_Hosp_Profee_Price UROLOGY ELECTRODE CUTTING 12 DEG UNIVERSAL QUICK FIRE MEDIUM LOOP WITH SHORTER LENGTH 2400254 CDM 272 RC facility both 897 897 Gross Charge Type: NIHD_Hosp_Profee_Price UROLOGY ELECTRODE CUTTING 12 DEG UNIVERSAL QUICK FIRE MEDIUM LOOP WITH SHORTER LENGTH 2400254 CDM 272 RC facility both 897 897 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE HEMI VAPORIZATION OVAL TIP 2400255 CDM 272 RC facility both 897 897 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE HEMI VAPORIZATION OVAL TIP 2400255 CDM 272 RC facility both 897 897 Gross Charge Type: NIHD_Hosp_Profee_Price SIGNIA POWER SHELL FOR POWER HANDLE 2400256 CDM 272 RC facility both 1824 1824 Gross Charge Type: NIHD_Hosp_Profee_Price SIGNIA POWER SHELL FOR POWER HANDLE 2400256 CDM 272 RC facility both 1824 1824 Gross Charge Type: NIHD_Hosp_Profee_Price UROLIFT 2 IMPLANT CARTRIDGE 2400350 CDM 278 RC facility both 13800 13800 Gross Charge Type: NIHD_Hosp_Profee_Price UROLIFT 2 IMPLANT CARTRIDGE 2400350 CDM 278 RC facility both 13800 13800 Gross Charge Type: NIHD_Hosp_Profee_Price UROLIFT 2 CARTRIDGE HANDLE KIT 2400351 CDM 278 RC facility both 3450 3450 Gross Charge Type: NIHD_Hosp_Profee_Price UROLIFT 2 CARTRIDGE HANDLE KIT 2400351 CDM 278 RC facility both 3450 3450 Gross Charge Type: NIHD_Hosp_Profee_Price GELPORT HAND ASSIST LAPAROSCOPIC SYSTEM 2400352 CDM 272 RC facility both 2145 2145 Gross Charge Type: NIHD_Hosp_Profee_Price GELPORT HAND ASSIST LAPAROSCOPIC SYSTEM 2400352 CDM 272 RC facility both 2145 2145 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON ASYMMETRIC PATELLA SZ A-29 X 9MM 2400610 CDM 278 RC facility both 5334 5334 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON ASYMMETRIC PATELLA SZ A-29 X 9MM 2400610 CDM 278 RC facility both 5334 5334 Gross Charge Type: NIHD_Hosp_Profee_Price GST WHITE VASCULAR RELOAD 60 MM 6 ROW FOR ECHELON FLEX POWERED STAPLER 2400700 CDM 278 RC facility both 723 723 Gross Charge Type: NIHD_Hosp_Profee_Price GST WHITE VASCULAR RELOAD 60 MM 6 ROW FOR ECHELON FLEX POWERED STAPLER 2400700 CDM 278 RC facility both 723 723 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 2 2400710 CDM 278 RC facility both 31500 31500 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 2 2400710 CDM 278 RC facility both 31500 31500 Gross Charge Type: NIHD_Hosp_Profee_Price "24071 EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 24071 CDM 982 RC 24071 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price "24071 EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 24071 CDM 982 RC 24071 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price "24075 Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm" 24075 CDM 521 RC 24075 HCPCS facility both 2425 2425 Gross Charge Type: NIHD_Clinic_Price "24076 EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMUSCULAR ProFee" 24076 CDM 982 RC 24076 HCPCS facility both 826 826 Gross Charge Type: NIHD_Hosp_Profee_Price "24076 EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMUSCULAR ProFee" 24076 CDM 982 RC 24076 HCPCS facility both 826 826 Gross Charge Type: NIHD_Hosp_Profee_Price "24105 EXCISION, OLECRANON BURSA ProFee" 24105 CDM 982 RC 24105 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price "24105 EXCISION, OLECRANON BURSA ProFee" 24105 CDM 982 RC 24105 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price 24200 Removal foreign body/upper arm/subcutaneous 24200 CDM 24200 HCPCS facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price 24200 Removal foreign body/upper arm/subcutaneous 24200 CDM 24200 HCPCS facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price 24201 REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP 24201 CDM 982 RC 24201 HCPCS facility both 1251 1251 Gross Charge Type: NIHD_Hosp_Profee_Price 24201 REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP 24201 CDM 982 RC 24201 HCPCS facility both 1251 1251 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Elbow Right - Report 242201 CDM 982 RC 24220 HCPCS facility both 26RT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Elbow Right - Report 242201 CDM 982 RC 24220 HCPCS facility both 26RT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Elbow Left - Report 242202 CDM 982 RC 24220 HCPCS facility both 26LT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Elbow Left - Report 242202 CDM 982 RC 24220 HCPCS facility both 26LT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Elbow Left 242203 CDM 761 RC facility both TCLT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Elbow Left 242203 CDM 761 RC facility both TCLT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Elbow Right 242204 CDM 761 RC facility both TCRT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Elbow Right 242204 CDM 761 RC facility both TCRT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price "24341 REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECOND ProFee" 24341 CDM 982 RC 24341 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "24341 REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECOND ProFee" 24341 CDM 982 RC 24341 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "24342 REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT ProFee" 24342 CDM 982 RC 24342 HCPCS facility both 1623 1623 Gross Charge Type: NIHD_Hosp_Profee_Price "24342 REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT ProFee" 24342 CDM 982 RC 24342 HCPCS facility both 1623 1623 Gross Charge Type: NIHD_Hosp_Profee_Price "24358 TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); ProFee" 24358 CDM 982 RC 24358 HCPCS facility both 1075 1075 Gross Charge Type: NIHD_Hosp_Profee_Price "24358 TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); ProFee" 24358 CDM 982 RC 24358 HCPCS facility both 1075 1075 Gross Charge Type: NIHD_Hosp_Profee_Price "24359 TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); ProFee" 24359 CDM 982 RC 24359 HCPCS facility both 1155 1155 Gross Charge Type: NIHD_Hosp_Profee_Price "24359 TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); ProFee" 24359 CDM 982 RC 24359 HCPCS facility both 1155 1155 Gross Charge Type: NIHD_Hosp_Profee_Price "24366 ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT ProFee" 24366 CDM 982 RC 24366 HCPCS facility both 1198 1198 Gross Charge Type: NIHD_Hosp_Profee_Price "24366 ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT ProFee" 24366 CDM 982 RC 24366 HCPCS facility both 1198 1198 Gross Charge Type: NIHD_Hosp_Profee_Price "24430 REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE) ProFee" 24430 CDM 982 RC 24430 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price "24430 REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE) ProFee" 24430 CDM 982 RC 24430 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price 24500 CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION ProFee 24500 CDM 982 RC 24500 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 24500 CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION ProFee 24500 CDM 982 RC 24500 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "24505 Closed treatment of humeral shaft fracture; with manipulation, w/wo skeletal traction" 245051 CDM 521 RC 24505 HCPCS facility both 910 910 Gross Charge Type: NIHD_RHC_Price "24505 Closed treatment of humeral shaft fracture; with manipulation, w/wo skeletal traction" 245051 CDM 521 RC 24505 HCPCS facility both 911 911 Gross Charge Type: NIHD_Clinic_Price 24505 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ TechFee 245052 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 24505 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ TechFee 245052 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "24505 CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETA ProFee" 245053 CDM 982 RC 24505 HCPCS facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "24505 CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETA ProFee" 245053 CDM 982 RC 24505 HCPCS facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "24515 OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE ProFee" 24515 CDM 982 RC 24515 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "24515 OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE ProFee" 24515 CDM 982 RC 24515 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price 24516 ASST IMN SHAFT 24516 CDM 982 RC 24516 HCPCS facility both 440 440 Gross Charge Type: NIHD_Hosp_Profee_Price 24516 ASST IMN SHAFT 24516 CDM 982 RC 24516 HCPCS facility both 440 440 Gross Charge Type: NIHD_Hosp_Profee_Price "24530 Closed tx supra/transcondylar humeral fx, w/wo intercondylar extension; w/o manip" 24530 CDM 521 RC 24530 HCPCS facility both 1409 1409 Gross Charge Type: NIHD_Clinic_Price "24535 Closed tx supra/transcondylar humeral fx, w/wo intercondylar extension; w/ manip" 24535 CDM 521 RC 24535 HCPCS facility both 955 955 Gross Charge Type: NIHD_RHC_Price "24535 Closed tx supra/transcondylar humeral fx, w/wo intercondylar extension; w/ manip" 24535 CDM 521 RC 24535 HCPCS facility both 955 955 Gross Charge Type: NIHD_Clinic_Price "24535 CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT I ProFee" 245351 CDM 982 RC 24535 HCPCS facility both 1851 1851 Gross Charge Type: NIHD_Hosp_Profee_Price "24535 CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT I ProFee" 245351 CDM 982 RC 24535 HCPCS facility both 1851 1851 Gross Charge Type: NIHD_Hosp_Profee_Price "24538 PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WIT ProFee" 24538 CDM 982 RC 24538 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "24538 PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WIT ProFee" 24538 CDM 982 RC 24538 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "24545 OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTERNAL F ProFee" 24545 CDM 982 RC 24545 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price "24545 OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTERNAL F ProFee" 24545 CDM 982 RC 24545 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price "24560 Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation" 24560 CDM 521 RC 24560 HCPCS facility both 529 529 Gross Charge Type: NIHD_RHC_Price "24560 Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation" 24560 CDM 521 RC 24560 HCPCS facility both 529 529 Gross Charge Type: NIHD_Clinic_Price "24575 OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNAL F ProFee" 24575 CDM 982 RC 24575 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price "24575 OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNAL F ProFee" 24575 CDM 982 RC 24575 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price "24576 Closed treatment of humeral condylar fracture, medial or lateral; without manipulation" 24576 CDM 521 RC 24576 HCPCS facility both 552 552 Gross Charge Type: NIHD_RHC_Price "24576 Closed treatment of humeral condylar fracture, medial or lateral; without manipulation" 24576 CDM 521 RC 24576 HCPCS facility both 552 552 Gross Charge Type: NIHD_Clinic_Price "24579 OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNAL FIXA ProFee" 24579 CDM 982 RC 24579 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price "24579 OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, INCLUDES INTERNAL FIXA ProFee" 24579 CDM 982 RC 24579 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price 24586 OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DIS ProFee 24586 CDM 982 RC 24586 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price 24586 OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DIS ProFee 24586 CDM 982 RC 24586 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price 24600 TREATMENT CLOSED ELBOW DISLOCATION W/O ANES TechFee 246001 CDM 450 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price 24600 TREATMENT CLOSED ELBOW DISLOCATION W/O ANES TechFee 246001 CDM 450 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price 24600 TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA ProFee 246002 CDM 982 RC 24600 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 24600 TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA ProFee 246002 CDM 982 RC 24600 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 24605 TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA ProFee 24605 CDM 982 RC 24605 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price 24605 TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA ProFee 24605 CDM 982 RC 24605 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price 24635 OPEN TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL E ProFee 24635 CDM 982 RC 24635 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price 24635 OPEN TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL E ProFee 24635 CDM 982 RC 24635 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price "24640 Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation" 246401 CDM 521 RC 24640 HCPCS facility both 599 599 Gross Charge Type: NIHD_RHC_Price "24640 Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation" 246401 CDM 521 RC 24640 HCPCS facility both 600 600 Gross Charge Type: NIHD_Clinic_Price 24640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ TechFee 246402 CDM 450 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price 24640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ TechFee 246402 CDM 450 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price "24640 CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, NURSEMAID ELBOW, WITH MANIPULATI ProFee" 246403 CDM 982 RC 24640 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "24640 CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, NURSEMAID ELBOW, WITH MANIPULATI ProFee" 246403 CDM 982 RC 24640 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 24650 Closed treatment of radial head or neck fracture; without manipulation 246501 CDM 521 RC 24650 HCPCS facility both 1076 1076 Gross Charge Type: NIHD_Clinic_Price 24650 CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION TechFee 246502 CDM 450 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 24650 CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION TechFee 246502 CDM 450 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 24650 CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT MANIPULATION ProFee 246503 CDM 982 RC 24650 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price 24650 CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT MANIPULATION ProFee 246503 CDM 982 RC 24650 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price 24655 - Radial Head/Neck w/ Manipulation 246551 CDM 450 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price 24655 - Radial Head/Neck w/ Manipulation 246551 CDM 450 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price 24655 CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH MANIPULATION ProFee 246552 CDM 982 RC 24655 HCPCS facility both 707 707 Gross Charge Type: NIHD_Hosp_Profee_Price 24655 CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH MANIPULATION ProFee 246552 CDM 982 RC 24655 HCPCS facility both 707 707 Gross Charge Type: NIHD_Hosp_Profee_Price "24665 OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RADIAL H ProFee" 24665 CDM 982 RC 24665 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "24665 OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RADIAL H ProFee" 24665 CDM 982 RC 24665 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "24666 OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RADIAL H ProFee" 24666 CDM 982 RC 24666 HCPCS facility both 1110 1110 Gross Charge Type: NIHD_Hosp_Profee_Price "24666 OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RADIAL H ProFee" 24666 CDM 982 RC 24666 HCPCS facility both 1110 1110 Gross Charge Type: NIHD_Hosp_Profee_Price "24670 CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES ProFee" 24670 CDM 982 RC 24670 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "24670 CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES ProFee" 24670 CDM 982 RC 24670 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "24675 CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES ProFee" 24675 CDM 982 RC 24675 HCPCS facility both 2208 2208 Gross Charge Type: NIHD_Hosp_Profee_Price "24675 CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES ProFee" 24675 CDM 982 RC 24675 HCPCS facility both 2208 2208 Gross Charge Type: NIHD_Hosp_Profee_Price "24685 OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]) ProFee" 24685 CDM 982 RC 24685 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "24685 OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]) ProFee" 24685 CDM 982 RC 24685 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price EpiFix 4x4cm SHEET 2472316 CDM 636 RC facility both 543 543 Gross Charge Type: NIHD_Hosp_Profee_Price EpiFix 4x4cm SHEET 2472316 CDM 636 RC facility both 543 543 Gross Charge Type: NIHD_Hosp_Profee_Price "25000 INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DEQUERVAINS DISEASE) ProFee" 25000 CDM 982 RC 25000 HCPCS facility both 621 621 Gross Charge Type: NIHD_Hosp_Profee_Price "25000 INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DEQUERVAINS DISEASE) ProFee" 25000 CDM 982 RC 25000 HCPCS facility both 621 621 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON CRUCIATE RETAINING FEMORAL SZ #1 LEFT 2500111 CDM 278 RC facility both 23508 23508 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON CRUCIATE RETAINING FEMORAL SZ #1 LEFT 2500111 CDM 278 RC facility both 23508 23508 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON BEARING INSERT SIZE #2 X 12MM 2500112 CDM 278 RC facility both 11346 11346 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON BEARING INSERT SIZE #2 X 12MM 2500112 CDM 278 RC facility both 11346 11346 Gross Charge Type: NIHD_Hosp_Profee_Price MONOCRYL 0 SUTURE 27INCHES LONG SH NEEDLE 2500120 CDM 272 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price MONOCRYL 0 SUTURE 27INCHES LONG SH NEEDLE 2500120 CDM 272 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 24 2500121 CDM 278 RC facility both 135 135 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW PROFILE CORTICAL 2.7X 24 2500121 CDM 278 RC facility both 135 135 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive VRS Glenoid with F.A.S.T. 2500350 CDM 278 RC facility both 33651 33651 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive VRS Glenoid with F.A.S.T. 2500350 CDM 278 RC facility both 33651 33651 Gross Charge Type: NIHD_Hosp_Profee_Price "25020 DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT; WITHOU ProFee" 25020 CDM 982 RC 25020 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "25020 DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR COMPARTMENT; WITHOU ProFee" 25020 CDM 982 RC 25020 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price Q2Roller Lateral Turning Device 2502409 CDM 272 RC facility both 333 333 Gross Charge Type: NIHD_Hosp_Profee_Price Q2Roller Lateral Turning Device 2502409 CDM 272 RC facility both 333 333 Gross Charge Type: NIHD_Hosp_Profee_Price "25028 INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA ProFee" 25028 CDM 982 RC 25028 HCPCS facility both 1075 1075 Gross Charge Type: NIHD_Hosp_Profee_Price "25028 INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA ProFee" 25028 CDM 982 RC 25028 HCPCS facility both 1075 1075 Gross Charge Type: NIHD_Hosp_Profee_Price "25040 ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF ProFee" 25040 CDM 982 RC 25040 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "25040 ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF ProFee" 25040 CDM 982 RC 25040 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "25075 Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm" 25075 CDM 521 RC 25075 HCPCS facility both 1852 1852 Gross Charge Type: NIHD_Clinic_Price "25076 EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFASCIAL (EG, INTRAMUSCUL ProFee" 25076 CDM 982 RC 25076 HCPCS facility both 1606.02 1606.02 Gross Charge Type: NIHD_Hosp_Profee_Price "25076 EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFASCIAL (EG, INTRAMUSCUL ProFee" 25076 CDM 982 RC 25076 HCPCS facility both 1606.02 1606.02 Gross Charge Type: NIHD_Hosp_Profee_Price "25101 ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHO ProFee" 25101 CDM 982 RC 25101 HCPCS facility both 714 714 Gross Charge Type: NIHD_Hosp_Profee_Price "25101 ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHO ProFee" 25101 CDM 982 RC 25101 HCPCS facility both 714 714 Gross Charge Type: NIHD_Hosp_Profee_Price "25111 EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY ProFee" 25111 CDM 982 RC 25111 HCPCS facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price "25111 EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY ProFee" 25111 CDM 982 RC 25111 HCPCS facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price "25115 RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVI ProFee" 25115 CDM 982 RC 25115 HCPCS facility both 1333 1333 Gross Charge Type: NIHD_Hosp_Profee_Price "25115 RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVI ProFee" 25115 CDM 982 RC 25115 HCPCS facility both 1333 1333 Gross Charge Type: NIHD_Hosp_Profee_Price "25118 SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT; ProFee" 25118 CDM 982 RC 25118 HCPCS facility both 1244 1244 Gross Charge Type: NIHD_Hosp_Profee_Price "25118 SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT; ProFee" 25118 CDM 982 RC 25118 HCPCS facility both 1244 1244 Gross Charge Type: NIHD_Hosp_Profee_Price 25120 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD O ProFee 25120 CDM 982 RC 25120 HCPCS facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price 25120 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD O ProFee 25120 CDM 982 RC 25120 HCPCS facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "XI RELOAD,SUREFORM 60 3.5 Blue" 2523701 CDM 272 RC facility both 723 723 Gross Charge Type: NIHD_Hosp_Profee_Price "XI RELOAD,SUREFORM 60 3.5 Blue" 2523701 CDM 272 RC facility both 723 723 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Wrist Right - Report 252461 CDM 982 RC 25246 HCPCS facility both 26RT 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Wrist Right - Report 252461 CDM 982 RC 25246 HCPCS facility both 26RT 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Wrist Left 252463 CDM 320 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Wrist Left 252463 CDM 320 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Wrist Right 252465 CDM 320 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Wrist Right 252465 CDM 320 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Wrist Left - Report 252466 CDM 982 RC 25246 HCPCS facility both 26LT 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Wrist Left - Report 252466 CDM 982 RC 25246 HCPCS facility both 26LT 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Wrist Left 252467 CDM 361 RC facility both TCLT 793 793 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Wrist Left 252467 CDM 361 RC facility both TCLT 793 793 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Wrist Right 252468 CDM 361 RC facility both TCRT 793 793 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Wrist Right 252468 CDM 361 RC facility both TCRT 793 793 Gross Charge Type: NIHD_Hosp_Profee_Price "25260 REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON O ProFee" 25260 CDM 982 RC 25260 HCPCS facility both 1151 1151 Gross Charge Type: NIHD_Hosp_Profee_Price "25260 REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON O ProFee" 25260 CDM 982 RC 25260 HCPCS facility both 1151 1151 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 8.0 2526509 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 8.0 2526509 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON PANOPTIX TORIC IOL CNWTT4 7.0 2526510 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON PANOPTIX TORIC IOL CNWTT4 7.0 2526510 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price "25270 REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON ProFee" 25270 CDM 982 RC 25270 HCPCS facility both 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price "25270 REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON ProFee" 25270 CDM 982 RC 25270 HCPCS facility both 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price Pressure Monitoring Kit with Single Pressure Transducer 2527457 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price Pressure Monitoring Kit with Single Pressure Transducer 2527457 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON PANOPTIX TORIC IOL CNWTT412.5 2528111 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON PANOPTIX TORIC IOL CNWTT412.5 2528111 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price "25295 TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON ProFee" 25295 CDM 982 RC 25295 HCPCS facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price "25295 TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON ProFee" 25295 CDM 982 RC 25295 HCPCS facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price "25312 TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; ProFee" 25312 CDM 975 RC 25312 HCPCS facility both 1088 1088 Gross Charge Type: NIHD_Hosp_Profee_Price "25312 TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; ProFee" 25312 CDM 975 RC 25312 HCPCS facility both 1088 1088 Gross Charge Type: NIHD_Hosp_Profee_Price "Puracol Plus AG+ Collagen Wound Dressing with Silver, 2"" W x 2.22"" L, in Educational Packaging" 2540496 CDM 272 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price "Puracol Plus AG+ Collagen Wound Dressing with Silver, 2"" W x 2.22"" L, in Educational Packaging" 2540496 CDM 272 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price "25415 REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNI ProFee" 25415 CDM 982 RC 25415 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "25415 REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNI ProFee" 25415 CDM 982 RC 25415 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price Compartment Pressure Monitoring Kit 2542393 CDM 272 RC facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price Compartment Pressure Monitoring Kit 2542393 CDM 272 RC facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price "Nonadhering Dressing, Silicone, 3"" x 4.25""" 2542464 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price "Nonadhering Dressing, Silicone, 3"" x 4.25""" 2542464 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price Matrix AG 4.34 x 4.34 Dressing 2544344 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Matrix AG 4.34 x 4.34 Dressing 2544344 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON VIVITY IOL CNWETO 12.5 2544600 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON VIVITY IOL CNWETO 12.5 2544600 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON VIVITY IOL CNWETO 13.0 2544601 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON VIVITY IOL CNWETO 13.0 2544601 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON VIVITY IOL CNWETO 13.5 2544602 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON VIVITY IOL CNWETO 13.5 2544602 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON VIVITY IOL CNWETO 20.0 2544603 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON VIVITY IOL CNWETO 20.0 2544603 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price "25447 ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS ProFee" 25447 CDM 982 RC 25447 HCPCS facility both 1264 1264 Gross Charge Type: NIHD_Hosp_Profee_Price "25447 ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS ProFee" 25447 CDM 982 RC 25447 HCPCS facility both 1264 1264 Gross Charge Type: NIHD_Hosp_Profee_Price 25505 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION ProFee 25505 CDM 982 RC 25505 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 25505 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION ProFee 25505 CDM 982 RC 25505 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "25515 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 25515 CDM 982 RC 25515 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price "25515 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 25515 CDM 982 RC 25515 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price 25520 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND CLOSED TREATMENT OF DISLOCATION OF DISTA ProFee 25520 CDM 982 RC 25520 HCPCS facility both 982 982 Gross Charge Type: NIHD_Hosp_Profee_Price 25520 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND CLOSED TREATMENT OF DISLOCATION OF DISTA ProFee 25520 CDM 982 RC 25520 HCPCS facility both 982 982 Gross Charge Type: NIHD_Hosp_Profee_Price "25525 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, A ProFee" 25525 CDM 982 RC 25525 HCPCS facility both 1652 1652 Gross Charge Type: NIHD_Hosp_Profee_Price "25525 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, A ProFee" 25525 CDM 982 RC 25525 HCPCS facility both 1652 1652 Gross Charge Type: NIHD_Hosp_Profee_Price "25526 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, A ProFee" 25526 CDM 982 RC 25526 HCPCS facility both 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price "25526 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, A ProFee" 25526 CDM 982 RC 25526 HCPCS facility both 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price 25530 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION ProFee 25530 CDM 982 RC 25530 HCPCS facility both 423 423 Gross Charge Type: NIHD_Hosp_Profee_Price 25530 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION ProFee 25530 CDM 982 RC 25530 HCPCS facility both 423 423 Gross Charge Type: NIHD_Hosp_Profee_Price 25530 Closed treatment of ulnar shaft fracture; without manipulation 255301 CDM 521 RC 25530 HCPCS facility both 415 415 Gross Charge Type: NIHD_RHC_Price 25530 Closed treatment of ulnar shaft fracture; without manipulation 255301 CDM 521 RC 25530 HCPCS facility both 415 415 Gross Charge Type: NIHD_Clinic_Price 25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION ProFee 25535 CDM 982 RC 25535 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price 25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION ProFee 25535 CDM 982 RC 25535 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price Suture Anchor 2.5mm PEEK 2554377 CDM 272 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price Suture Anchor 2.5mm PEEK 2554377 CDM 272 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price "25545 OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 25545 CDM 982 RC 25545 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "25545 OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 25545 CDM 982 RC 25545 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price 25565 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ TechFee 255651 CDM 450 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 25565 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ TechFee 255651 CDM 450 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 25565 CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION ProFee 255652 CDM 982 RC 25565 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price 25565 CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION ProFee 255652 CDM 982 RC 25565 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price "25575 OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN PERFO ProFee" 25575 CDM 982 RC 25575 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "25575 OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN PERFO ProFee" 25575 CDM 982 RC 25575 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price 25600 Closed treatment of distal radial fracture; without manipulation 256001 CDM 521 RC 25600 HCPCS facility both 983 983 Gross Charge Type: NIHD_Clinic_Price 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee 256002 CDM 450 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee 256002 CDM 450 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price "25600 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SE ProFee" 256003 CDM 982 RC 25600 HCPCS facility both 656 656 Gross Charge Type: NIHD_Hosp_Profee_Price "25600 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SE ProFee" 256003 CDM 982 RC 25600 HCPCS facility both 656 656 Gross Charge Type: NIHD_Hosp_Profee_Price 25605 Closed treatment of distal radial fracture; with manipulation 256051 CDM 521 RC 25605 HCPCS facility both 2124 2124 Gross Charge Type: NIHD_Clinic_Price 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF TechFee 256052 CDM 450 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF TechFee 256052 CDM 450 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price "25605 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SE ProFee" 256053 CDM 982 RC 25605 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "25605 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SE ProFee" 256053 CDM 982 RC 25605 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 25606 PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION ProFee 25606 CDM 982 RC 25606 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 25606 PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION ProFee 25606 CDM 982 RC 25606 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price "25607 OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION, WIT ProFee" 25607 CDM 982 RC 25607 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "25607 OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION, WIT ProFee" 25607 CDM 982 RC 25607 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price 25608 OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WIT ProFee 25608 CDM 982 RC 25608 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price 25608 OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WIT ProFee 25608 CDM 982 RC 25608 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price 25609 OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WIT ProFee 25609 CDM 982 RC 25609 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price 25609 OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WIT ProFee 25609 CDM 982 RC 25609 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price 25624 CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITH MANIPULATION ProFee 25624 CDM 982 RC 25624 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price 25624 CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITH MANIPULATION ProFee 25624 CDM 982 RC 25624 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "25628 OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, INCLUDES INTERNAL FIXATION, WH ProFee" 25628 CDM 982 RC 25628 HCPCS facility both 1523 1523 Gross Charge Type: NIHD_Hosp_Profee_Price "25628 OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, INCLUDES INTERNAL FIXATION, WH ProFee" 25628 CDM 982 RC 25628 HCPCS facility both 1523 1523 Gross Charge Type: NIHD_Hosp_Profee_Price 25630 Closed treatment of carpal bone fracture; without manipulation 25630 CDM 521 RC 25630 HCPCS facility both 547 547 Gross Charge Type: NIHD_RHC_Price 25630 Closed treatment of carpal bone fracture; without manipulation 25630 CDM 521 RC 25630 HCPCS facility both 547 547 Gross Charge Type: NIHD_Clinic_Price "25645 OPEN TREATMENT OF CARPAL BONE FRACTURE (OTHER THAN CARPAL SCAPHOID [NAVICULAR]), EACH ProFee" 25645 CDM 982 RC 25645 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price "25645 OPEN TREATMENT OF CARPAL BONE FRACTURE (OTHER THAN CARPAL SCAPHOID [NAVICULAR]), EACH ProFee" 25645 CDM 982 RC 25645 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price 25650 Closed treatment of ulnar styloid fracture 25650 CDM 521 RC 25650 HCPCS facility both 523 523 Gross Charge Type: NIHD_RHC_Price 25650 Closed treatment of ulnar styloid fracture 25650 CDM 521 RC 25650 HCPCS facility both 523 523 Gross Charge Type: NIHD_Clinic_Price 25651 PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE ProFee 25651 CDM 982 RC 25651 HCPCS facility both 887 887 Gross Charge Type: NIHD_Hosp_Profee_Price 25651 PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE ProFee 25651 CDM 982 RC 25651 HCPCS facility both 887 887 Gross Charge Type: NIHD_Hosp_Profee_Price 25652 OPEN TREATMENT OF ULNAR STYLOID FRACTURE ProFee 25652 CDM 982 RC 25652 HCPCS facility both 1135 1135 Gross Charge Type: NIHD_Hosp_Profee_Price 25652 OPEN TREATMENT OF ULNAR STYLOID FRACTURE ProFee 25652 CDM 982 RC 25652 HCPCS facility both 1135 1135 Gross Charge Type: NIHD_Hosp_Profee_Price "25680 CLOSED TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION, WITH MANIPULAT ProFee" 25680 CDM 982 RC 25680 HCPCS facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price "25680 CLOSED TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION, WITH MANIPULAT ProFee" 25680 CDM 982 RC 25680 HCPCS facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price "25690 CLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATION ProFee" 25690 CDM 25690 HCPCS facility both 758 758 Gross Charge Type: NIHD_Hosp_Profee_Price "25690 CLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATION ProFee" 25690 CDM 25690 HCPCS facility both 758 758 Gross Charge Type: NIHD_Hosp_Profee_Price 25690 CLOSED TX LUNATE DISLOCATION W/MANIPULATION TechFee 256901 CDM 450 RC facility both 2087 2087 Gross Charge Type: NIHD_Hosp_Profee_Price 25690 CLOSED TX LUNATE DISLOCATION W/MANIPULATION TechFee 256901 CDM 450 RC facility both 2087 2087 Gross Charge Type: NIHD_Hosp_Profee_Price Clavicle Non Locking Screw 3.5 x 12 2570503 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price Clavicle Non Locking Screw 3.5 x 12 2570503 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price Polar Care Kodiak Cold Therapy Kit with Intelli-Flo Knee Pad Knee 2574338 CDM 272 RC facility both 234 234 Gross Charge Type: NIHD_Hosp_Profee_Price Polar Care Kodiak Cold Therapy Kit with Intelli-Flo Knee Pad Knee 2574338 CDM 272 RC facility both 234 234 Gross Charge Type: NIHD_Hosp_Profee_Price EpiCord 2x3cm 2590299 CDM 636 RC facility both 545 545 Gross Charge Type: NIHD_Hosp_Profee_Price EpiCord 2x3cm 2590299 CDM 636 RC facility both 545 545 Gross Charge Type: NIHD_Hosp_Profee_Price Bio-A Tissue Reinforcement 9x15 2590307 CDM 278 RC facility both 2048 2048 Gross Charge Type: NIHD_Hosp_Profee_Price Bio-A Tissue Reinforcement 9x15 2590307 CDM 278 RC facility both 2048 2048 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 14.5 2596454 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 14.5 2596454 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Locking Screw 2.7mm x 16 2598758 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price Locking Screw 2.7mm x 16 2598758 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price Locking Screw 2.7mm x 8mm 2600543 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price Locking Screw 2.7mm x 8mm 2600543 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 FULL THREAD 3.5mm / L8mm 2600544 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 FULL THREAD 3.5mm / L8mm 2600544 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L44" 2600638 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L44" 2600638 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price 26010 Drainage of finger abscess; simple 260101 CDM 521 RC 26010 HCPCS facility both 526 526 Gross Charge Type: NIHD_RHC_Price 26010 Drainage of finger abscess; simple 260101 CDM 521 RC 26010 HCPCS facility both 526 526 Gross Charge Type: NIHD_Clinic_Price 26010 DRAINAGE FINGER ABSCESS SIMPLE TechFee 260102 CDM 450 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price 26010 DRAINAGE FINGER ABSCESS SIMPLE TechFee 260102 CDM 450 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price 26010 DRAINAGE FINGER TIP ABSCESS SI CHARGE 260104 CDM 761 RC facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price 26010 DRAINAGE FINGER TIP ABSCESS SI CHARGE 260104 CDM 761 RC facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price 26010 DRAINAGE OF FINGER ABSCESS; SIMPLE ProFee 260105 CDM 982 RC 26010 HCPCS facility both 244 244 Gross Charge Type: NIHD_Hosp_Profee_Price 26010 DRAINAGE OF FINGER ABSCESS; SIMPLE ProFee 260105 CDM 982 RC 26010 HCPCS facility both 244 244 Gross Charge Type: NIHD_Hosp_Profee_Price 26011 DRAINAGE FINGER TIP ABSCESS CO CHARGE 26011 CDM 761 RC facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price 26011 DRAINAGE FINGER TIP ABSCESS CO CHARGE 26011 CDM 761 RC facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price 26011 DRAINAGE FINGER ABSCESS COMPLICATED TechFee 260111 CDM 450 RC facility both 2879 2879 Gross Charge Type: NIHD_Hosp_Profee_Price 26011 DRAINAGE FINGER ABSCESS COMPLICATED TechFee 260111 CDM 450 RC facility both 2879 2879 Gross Charge Type: NIHD_Hosp_Profee_Price "26011 DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON) ProFee" 260112 CDM 982 RC 26011 HCPCS facility both 1174 1174 Gross Charge Type: NIHD_Hosp_Profee_Price "26011 DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON) ProFee" 260112 CDM 982 RC 26011 HCPCS facility both 1174 1174 Gross Charge Type: NIHD_Hosp_Profee_Price "26020 DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH ProFee" 26020 CDM 982 RC 26020 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "26020 DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH ProFee" 26020 CDM 982 RC 26020 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "26025 DRAINAGE OF PALMAR BURSA; SINGLE, BURSA ProFee" 26025 CDM 982 RC 26025 HCPCS facility both 771 771 Gross Charge Type: NIHD_Hosp_Profee_Price "26025 DRAINAGE OF PALMAR BURSA; SINGLE, BURSA ProFee" 26025 CDM 982 RC 26025 HCPCS facility both 771 771 Gross Charge Type: NIHD_Hosp_Profee_Price "26034 INCISION, BONE CORTEX, HAND OR FINGER (EG, OSTEOMYELITIS OR BONE ABSCESS) ProFee" 26034 CDM 26034 HCPCS facility both 847 847 Gross Charge Type: NIHD_Hosp_Profee_Price "26034 INCISION, BONE CORTEX, HAND OR FINGER (EG, OSTEOMYELITIS OR BONE ABSCESS) ProFee" 26034 CDM 26034 HCPCS facility both 847 847 Gross Charge Type: NIHD_Hosp_Profee_Price "26045 FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); OPEN, PARTIAL ProFee" 26045 CDM 982 RC 26045 HCPCS facility both 853 853 Gross Charge Type: NIHD_Hosp_Profee_Price "26045 FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); OPEN, PARTIAL ProFee" 26045 CDM 982 RC 26045 HCPCS facility both 853 853 Gross Charge Type: NIHD_Hosp_Profee_Price "26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER) ProFee" 26055 CDM 982 RC 26055 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER) ProFee" 26055 CDM 982 RC 26055 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "26075 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; METACARPO ProFee" 26075 CDM 982 RC 26075 HCPCS facility both 595 595 Gross Charge Type: NIHD_Hosp_Profee_Price "26075 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; METACARPO ProFee" 26075 CDM 982 RC 26075 HCPCS facility both 595 595 Gross Charge Type: NIHD_Hosp_Profee_Price "26080 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHAL ProFee" 26080 CDM 982 RC 26080 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price "26080 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHAL ProFee" 26080 CDM 982 RC 26080 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price TOGGLELOC 2.9MM W/NDLS 2608960 CDM 278 RC facility both 1676 1676 Gross Charge Type: NIHD_Hosp_Profee_Price TOGGLELOC 2.9MM W/NDLS 2608960 CDM 278 RC facility both 1676 1676 Gross Charge Type: NIHD_Hosp_Profee_Price "26111 EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; ProFee" 26111 CDM 982 RC 26111 HCPCS facility both 764 764 Gross Charge Type: NIHD_Hosp_Profee_Price "26111 EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; ProFee" 26111 CDM 982 RC 26111 HCPCS facility both 764 764 Gross Charge Type: NIHD_Hosp_Profee_Price "26115 EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; ProFee" 26115 CDM 982 RC 26115 HCPCS facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price "26115 EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; ProFee" 26115 CDM 982 RC 26115 HCPCS facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price "26160 EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLI ProFee" 26160 CDM 982 RC 26160 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "26160 EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLI ProFee" 26160 CDM 982 RC 26160 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz7 LFT CR 2616340 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz7 LFT CR 2616340 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L20mm" 2616368 CDM 278 RC facility both 390 390 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L20mm" 2616368 CDM 278 RC facility both 390 390 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L24mm" 2616369 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L24mm" 2616369 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L26mm" 2616370 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L26mm" 2616370 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 7X10MM 2617002 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 7X10MM 2617002 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L22mm" 2617050 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L22mm" 2617050 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L24mm" 2617051 CDM 278 RC facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L24mm" 2617051 CDM 278 RC facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L28mm" 2617052 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L28mm" 2617052 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L32mm" 2617055 CDM 278 RC facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L32mm" 2617055 CDM 278 RC facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L16mm" 2617058 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L16mm" 2617058 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L22mm" 2617059 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L22mm" 2617059 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L12mm" 2617218 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L12mm" 2617218 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L14mm" 2617219 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L14mm" 2617219 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L18mm" 2617220 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L18mm" 2617220 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L20mm" 2617221 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L20mm" 2617221 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L14mm" 2617227 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L14mm" 2617227 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L22mm" 2617228 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L22mm" 2617228 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L24mm" 2617229 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L24mm" 2617229 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L32mm" 2617231 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L32mm" 2617231 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L34mm" 2617232 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L34mm" 2617232 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L36mm" 2617233 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L36mm" 2617233 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L46mm" 2617269 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L46mm" 2617269 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L48mm" 2617270 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L48mm" 2617270 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L50mm" 2617271 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L50mm" 2617271 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L55mm" 2617272 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L55mm" 2617272 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L60mm" 2617273 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L60mm" 2617273 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L10mm" 2617275 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L10mm" 2617275 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L22mm" 2617277 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L22mm" 2617277 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L26mm" 2617279 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L26mm" 2617279 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L28mm" 2617280 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L28mm" 2617280 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L30mm" 2617281 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L30mm" 2617281 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L36mm" 2617282 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L36mm" 2617282 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L18mm" 2617323 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L18mm" 2617323 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L22mm" 2617324 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L22mm" 2617324 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL STEM 8.0X4.0MM 2617342 CDM 278 RC facility both 8273 8273 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL STEM 8.0X4.0MM 2617342 CDM 278 RC facility both 8273 8273 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL HEAD 22.0MM RIGHT 2617344 CDM 278 RC facility both 14131 14131 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL HEAD 22.0MM RIGHT 2617344 CDM 278 RC facility both 14131 14131 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L36mm" 2617350 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L36mm" 2617350 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L38mm" 2617351 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L38mm" 2617351 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L40mm" 2617352 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L40mm" 2617352 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L42mm" 2617353 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L42mm" 2617353 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L44mm" 2617354 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L44mm" 2617354 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L46mm" 2617355 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L46mm" 2617355 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L48mm" 2617356 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L48mm" 2617356 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L26mm" 2617358 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L26mm" 2617358 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L28mm" 2617384 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L28mm" 2617384 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L70mm" 2617386 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L70mm" 2617386 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L16mm" 2618358 CDM 278 RC facility both 390 390 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L16mm" 2618358 CDM 278 RC facility both 390 390 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L18mm" 2618359 CDM 278 RC facility both 390 390 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L18mm" 2618359 CDM 278 RC facility both 390 390 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L22mm" 2618360 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T8 Full Thread, 2.4mm/L22mm" 2618360 CDM 278 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L16mm" 2618982 CDM 278 RC facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.4mm/L16mm" 2618982 CDM 278 RC facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L10mm" 2618988 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L10mm" 2618988 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L12mm" 2618989 CDM 278 RC facility both 340 340 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L12mm" 2618989 CDM 278 RC facility both 340 340 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L14mm" 2618990 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L14mm" 2618990 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L18mm" 2618991 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L18mm" 2618991 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L26mm" 2620325 CDM 278 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L26mm" 2620325 CDM 278 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L16mm" 2620336 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L16mm" 2620336 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L22mm" 2620337 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L22mm" 2620337 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L26mm" 2620338 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L26mm" 2620338 CDM 278 RC facility both 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L30mm" 2620340 CDM 272 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T8 Full Thread, 2.7mm/L30mm" 2620340 CDM 272 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L10mm" 2620347 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L10mm" 2620347 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L18mm" 2620348 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L18mm" 2620348 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L20mm" 2620349 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L20mm" 2620349 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L26mm" 2620350 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L26mm" 2620350 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L28mm" 2620351 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L28mm" 2620351 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L30mm" 2620352 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L30mm" 2620352 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L38mm" 2620353 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L38mm" 2620353 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L40mm" 2620355 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L40mm" 2620355 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L42mm" 2620389 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L42mm" 2620389 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L44mm" 2620390 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L44mm" 2620390 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L65mm" 2620391 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L65mm" 2620391 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L70mm" 2620393 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw, T10 Full Thread, 2.7mm/L70mm" 2620393 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L12mm" 2620394 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L12mm" 2620394 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L14mm" 2620395 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L14mm" 2620395 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L16mm" 2620396 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L16mm" 2620396 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L18mm" 2620397 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L18mm" 2620397 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L24mm" 2620398 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L24mm" 2620398 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L32mm" 2620399 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L32mm" 2620399 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L34mm" 2620400 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw, T10 Full Thread, 2.7mm/L34mm" 2620400 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L20mm" 2620452 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L20mm" 2620452 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L50mm" 2620473 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L50mm" 2620473 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L55mm" 2620474 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L55mm" 2620474 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L60mm" 2620475 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L60mm" 2620475 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L70mm" 2620476 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw VariAx2 T10, Full Thread, 3.5mm / L70mm" 2620476 CDM 278 RC facility both 365 365 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L10mm" 2620477 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L10mm" 2620477 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L20mm" 2620478 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L20mm" 2620478 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L22mm" 2620479 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L22mm" 2620479 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L24mm" 2620481 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L24mm" 2620481 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L42mm" 2620485 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L42mm" 2620485 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L48mm" 2620486 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L48mm" 2620486 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price Precision thin long med blade 9.0 x 0.38 x 18.5 2620498 CDM 272 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price Precision thin long med blade 9.0 x 0.38 x 18.5 2620498 CDM 272 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L34mm" 2620504 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L34mm" 2620504 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L38mm" 2620506 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L38mm" 2620506 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L40mm" 2620507 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L40mm" 2620507 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L60mm" 2620510 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L60mm" 2620510 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L65mm" 2620511 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L65mm" 2620511 CDM 278 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price Cannulated Screw 7.3mm Thread 16MM Length 85mm 2620540 CDM 278 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price Cannulated Screw 7.3mm Thread 16MM Length 85mm 2620540 CDM 278 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price Cannulated Screw 7.3mm Thread 16MM Length 90mm 2620541 CDM 278 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price Cannulated Screw 7.3mm Thread 16MM Length 90mm 2620541 CDM 278 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price Attune CRS RP INSRT SZ 6 22MM 2621782 CDM 278 RC facility both 19078 19078 Gross Charge Type: NIHD_Hosp_Profee_Price Attune CRS RP INSRT SZ 6 22MM 2621782 CDM 278 RC facility both 19078 19078 Gross Charge Type: NIHD_Hosp_Profee_Price Cannulated Screw 7.3mm Thread 16MM Length 80mm 2622303 CDM 278 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price Cannulated Screw 7.3mm Thread 16MM Length 80mm 2622303 CDM 278 RC facility both 765 765 Gross Charge Type: NIHD_Hosp_Profee_Price "26236 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELI ProFee" 26236 CDM 982 RC 26236 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "26236 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELI ProFee" 26236 CDM 982 RC 26236 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price Attune CRS RP INSRT SZ 6 24MM 2630718 CDM 278 RC facility both 19078 19078 Gross Charge Type: NIHD_Hosp_Profee_Price Attune CRS RP INSRT SZ 6 24MM 2630718 CDM 278 RC facility both 19078 19078 Gross Charge Type: NIHD_Hosp_Profee_Price 26320 REMOVAL OF IMPLANT FROM FINGER OR HAND ProFee 26320 CDM 982 RC 26320 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price 26320 REMOVAL OF IMPLANT FROM FINGER OR HAND ProFee 26320 CDM 982 RC 26320 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price "26341 Manipulation, palmar fascial cord, post enzyme injection, single cord" 26341 CDM 521 RC 26341 HCPCS facility both 393 393 Gross Charge Type: NIHD_RHC_Price "26341 Manipulation, palmar fascial cord, post enzyme injection, single cord" 26341 CDM 521 RC 26341 HCPCS facility both 393 393 Gross Charge Type: NIHD_Clinic_Price T2 NUT FOR CONDYLE SCREW 05MM 2634487 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price T2 NUT FOR CONDYLE SCREW 05MM 2634487 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price T2 CONDYLE SCREW 5mmX60mm 2634488 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price T2 CONDYLE SCREW 5mmX60mm 2634488 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price T2 CONDYLE SCREW 5mmX70mm 2634489 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price T2 CONDYLE SCREW 5mmX70mm 2634489 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price T2 CONDYLE SCREW 5mmX75mm 2634490 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price T2 CONDYLE SCREW 5mmX75mm 2634490 CDM 278 RC facility both 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT AO 0.26X220MM 2634618 CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT AO 0.26X220MM 2634618 CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price "26350 REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH (EG, ProFee" 26350 CDM 982 RC 26350 HCPCS facility both 1299 1299 Gross Charge Type: NIHD_Hosp_Profee_Price "26350 REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH (EG, ProFee" 26350 CDM 982 RC 26350 HCPCS facility both 1299 1299 Gross Charge Type: NIHD_Hosp_Profee_Price "26356 REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH (EG, NO M ProFee" 26356 CDM 982 RC 26356 HCPCS facility both 1220 1220 Gross Charge Type: NIHD_Hosp_Profee_Price "26356 REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN ZONE 2 DIGITAL FLEXOR TENDON SHEATH (EG, NO M ProFee" 26356 CDM 982 RC 26356 HCPCS facility both 1220 1220 Gross Charge Type: NIHD_Hosp_Profee_Price "26370 REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON; PRIMARY, ProFee" 26370 CDM 982 RC 26370 HCPCS facility both 1367 1367 Gross Charge Type: NIHD_Hosp_Profee_Price "26370 REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACT SUPERFICIALIS TENDON; PRIMARY, ProFee" 26370 CDM 982 RC 26370 HCPCS facility both 1367 1367 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive VRS Mini Taper Adapter 2637613 CDM 278 RC facility both 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive VRS Mini Taper Adapter 2637613 CDM 278 RC facility both 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 3X4 CM 2637681 CDM 636 RC facility both 273 273 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING PURAPLY AM 3X4 CM 2637681 CDM 636 RC facility both 273 273 Gross Charge Type: NIHD_Hosp_Profee_Price "AlloSync Pure, 10.0cc" 2638311 CDM 278 RC facility both 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price "AlloSync Pure, 10.0cc" 2638311 CDM 278 RC facility both 4452 4452 Gross Charge Type: NIHD_Hosp_Profee_Price "AlloSync injectable fibers, 5cc" 2638312 CDM 278 RC facility both 1964 1964 Gross Charge Type: NIHD_Hosp_Profee_Price "AlloSync injectable fibers, 5cc" 2638312 CDM 278 RC facility both 1964 1964 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO-PRO TI 3.5MMX18MM 2639262 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO-PRO TI 3.5MMX18MM 2639262 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive VRS Drill 2640354 CDM 272 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive VRS Drill 2640354 CDM 272 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price "Comprehensive VRS Glenoid Reamer Guide, Bone & Implant Model" 2640356 CDM 278 RC facility both 2383 2383 Gross Charge Type: NIHD_Hosp_Profee_Price "Comprehensive VRS Glenoid Reamer Guide, Bone & Implant Model" 2640356 CDM 278 RC facility both 2383 2383 Gross Charge Type: NIHD_Hosp_Profee_Price "26410 REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON ProFee" 26410 CDM 982 RC 26410 HCPCS facility both 1162 1162 Gross Charge Type: NIHD_Hosp_Profee_Price "26410 REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON ProFee" 26410 CDM 982 RC 26410 HCPCS facility both 1162 1162 Gross Charge Type: NIHD_Hosp_Profee_Price "26418 REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON ProFee" 26418 CDM 982 RC 26418 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "26418 REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON ProFee" 26418 CDM 982 RC 26418 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT6 20.0 2642416 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT6 20.0 2642416 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Locking Compression Plate 8 Hole L155MM 5.0MM 2642471 CDM 278 RC facility both 5981 5981 Gross Charge Type: NIHD_Hosp_Profee_Price Locking Compression Plate 8 Hole L155MM 5.0MM 2642471 CDM 278 RC facility both 5981 5981 Gross Charge Type: NIHD_Hosp_Profee_Price "26445 TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER, EACH TENDON ProFee" 26445 CDM 982 RC 26445 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "26445 TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER, EACH TENDON ProFee" 26445 CDM 982 RC 26445 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "26455 TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON ProFee" 26455 CDM 982 RC 26455 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price "26455 TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON ProFee" 26455 CDM 982 RC 26455 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price "26474 TENODESIS; OF DISTAL JOINT, EACH JOINT ProFee" 26474 CDM 982 RC 26474 HCPCS facility both 1099 1099 Gross Charge Type: NIHD_Hosp_Profee_Price "26474 TENODESIS; OF DISTAL JOINT, EACH JOINT ProFee" 26474 CDM 982 RC 26474 HCPCS facility both 1099 1099 Gross Charge Type: NIHD_Hosp_Profee_Price "26480 TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA OR DORSUM OF HAND; WITHOUT FREE ProFee" 26480 CDM 982 RC 26480 HCPCS facility both 12314 12314 Gross Charge Type: NIHD_Hosp_Profee_Price "26480 TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA OR DORSUM OF HAND; WITHOUT FREE ProFee" 26480 CDM 982 RC 26480 HCPCS facility both 12314 12314 Gross Charge Type: NIHD_Hosp_Profee_Price "26540 REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT ProFee" 26540 CDM 982 RC 26540 HCPCS facility both 1095 1095 Gross Charge Type: NIHD_Hosp_Profee_Price "26540 REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT ProFee" 26540 CDM 982 RC 26540 HCPCS facility both 1095 1095 Gross Charge Type: NIHD_Hosp_Profee_Price "26546 REPAIR NON-UNION, METACARPAL OR PHALANX (INCLUDES OBTAINING BONE GRAFT WITH OR WITHOUT ProFee" 26546 CDM 982 RC 26546 HCPCS facility both 1804 1804 Gross Charge Type: NIHD_Hosp_Profee_Price "26546 REPAIR NON-UNION, METACARPAL OR PHALANX (INCLUDES OBTAINING BONE GRAFT WITH OR WITHOUT ProFee" 26546 CDM 982 RC 26546 HCPCS facility both 1804 1804 Gross Charge Type: NIHD_Hosp_Profee_Price "26600 Closed treatment of metacarpal fracture, single; without manipulation, each bone" 266001 CDM 521 RC 26600 HCPCS facility both 851 851 Gross Charge Type: NIHD_Clinic_Price 26600 CLTX METACARPAL FX W/O MANIPULATION EACH BONE TechFee 266002 CDM 450 RC facility both 484 484 Gross Charge Type: NIHD_Hosp_Profee_Price 26600 CLTX METACARPAL FX W/O MANIPULATION EACH BONE TechFee 266002 CDM 450 RC facility both 484 484 Gross Charge Type: NIHD_Hosp_Profee_Price "26600 CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE ProFee" 266003 CDM 982 RC 26600 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price "26600 CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE ProFee" 266003 CDM 982 RC 26600 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price "Xtrasorb Superabsorbent Wound Dressing, Sterile, 6"" x 9""" 2660326 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "Xtrasorb Superabsorbent Wound Dressing, Sterile, 6"" x 9""" 2660326 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "26605 Closed treatment of metacarpal fracture, single; with manipulation, each bone" 266051 CDM 521 RC 26605 HCPCS facility both 1104 1104 Gross Charge Type: NIHD_Clinic_Price 26605 CLTX METACARPAL FX W/MANIPULATION EACH BONE TechFee 266052 CDM 450 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 26605 CLTX METACARPAL FX W/MANIPULATION EACH BONE TechFee 266052 CDM 450 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "26605 CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE ProFee" 266053 CDM 982 RC 26605 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "26605 CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE ProFee" 266053 CDM 982 RC 26605 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "26608 PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE ProFee" 26608 CDM 982 RC 26608 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "26608 PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE ProFee" 26608 CDM 982 RC 26608 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "26615 OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, INCLUDES INTERNAL FIXATION, WHEN PERFOR ProFee" 26615 CDM 982 RC 26615 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "26615 OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, INCLUDES INTERNAL FIXATION, WHEN PERFOR ProFee" 26615 CDM 982 RC 26615 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 7 2661710 CDM 278 RC facility both 22060 22060 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 7 2661710 CDM 278 RC facility both 22060 22060 Gross Charge Type: NIHD_Hosp_Profee_Price RHS Short Radial Stem DIA 8MM Neck 16MM 2661751 CDM 278 RC facility both 12086 12086 Gross Charge Type: NIHD_Hosp_Profee_Price RHS Short Radial Stem DIA 8MM Neck 16MM 2661751 CDM 278 RC facility both 12086 12086 Gross Charge Type: NIHD_Hosp_Profee_Price Flexiva Pulse ID Trac Tip Fiber 2663335 CDM 278 RC facility both 1035 1035 Gross Charge Type: NIHD_Hosp_Profee_Price Flexiva Pulse ID Trac Tip Fiber 2663335 CDM 278 RC facility both 1035 1035 Gross Charge Type: NIHD_Hosp_Profee_Price Flexiva Pulse ID 242 Fiber 2663336 CDM 278 RC facility both 848 848 Gross Charge Type: NIHD_Hosp_Profee_Price Flexiva Pulse ID 242 Fiber 2663336 CDM 278 RC facility both 848 848 Gross Charge Type: NIHD_Hosp_Profee_Price Micro Dual Cut (9.0 x 0.38 x 25.0mm) 2663497 CDM 272 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price Micro Dual Cut (9.0 x 0.38 x 25.0mm) 2663497 CDM 272 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 8 2663543 CDM 278 RC facility both 26688 26688 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM INSIGNIA STANDARD OFFSET SZE 8 2663543 CDM 278 RC facility both 26688 26688 Gross Charge Type: NIHD_Hosp_Profee_Price Percuflex Locking Nephr Cath 10.3 X 28 2663678 CDM 272 RC facility both 173 173 Gross Charge Type: NIHD_Hosp_Profee_Price Percuflex Locking Nephr Cath 10.3 X 28 2663678 CDM 272 RC facility both 173 173 Gross Charge Type: NIHD_Hosp_Profee_Price "26641 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITH MANIPULATION ProFee" 26641 CDM 982 RC 26641 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "26641 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITH MANIPULATION ProFee" 26641 CDM 982 RC 26641 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "26650 PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT ProFee" 26650 CDM 982 RC 26650 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "26650 PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT ProFee" 26650 CDM 982 RC 26650 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price PrecisionPoint Transperineal Access System 2666388 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price PrecisionPoint Transperineal Access System 2666388 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price RHS Radial Head DIA 20MM 2666389 CDM 278 RC facility both 6510 6510 Gross Charge Type: NIHD_Hosp_Profee_Price RHS Radial Head DIA 20MM 2666389 CDM 278 RC facility both 6510 6510 Gross Charge Type: NIHD_Hosp_Profee_Price "26665 OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), INCL ProFee" 26665 CDM 982 RC 26665 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "26665 OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), INCL ProFee" 26665 CDM 982 RC 26665 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price 26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES TechFee 26670 CDM 450 RC facility both 620 620 Gross Charge Type: NIHD_Hosp_Profee_Price 26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES TechFee 26670 CDM 450 RC facility both 620 620 Gross Charge Type: NIHD_Hosp_Profee_Price 26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES ProFee 266701 CDM 981 RC 26670 HCPCS facility both 485 485 Gross Charge Type: NIHD_Hosp_Profee_Price 26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES ProFee 266701 CDM 981 RC 26670 HCPCS facility both 485 485 Gross Charge Type: NIHD_Hosp_Profee_Price "26675 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH MANIPULATION, ProFee" 26675 CDM 982 RC 26675 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "26675 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH MANIPULATION, ProFee" 26675 CDM 982 RC 26675 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "26676 PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH ProFee" 26676 CDM 982 RC 26676 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "26676 PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH ProFee" 26676 CDM 982 RC 26676 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "Universal Hook with Cautery Tip, 32 cm" 2668447 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price "Universal Hook with Cautery Tip, 32 cm" 2668447 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price 8/10 DILATOR/ SHEATH SET 2668458 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price 8/10 DILATOR/ SHEATH SET 2668458 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price "26685 OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; INCLUDES INTERNAL FIX ProFee" 26685 CDM 982 RC 26685 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "26685 OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; INCLUDES INTERNAL FIX ProFee" 26685 CDM 982 RC 26685 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price 26700 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES TechFee 267001 CDM 450 RC facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price 26700 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES TechFee 267001 CDM 450 RC facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price "26700 CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; WITHOU ProFee" 267002 CDM 982 RC 26700 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "26700 CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; WITHOU ProFee" 267002 CDM 982 RC 26700 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price CONMED SUCTION IRRIGATOR ELECTROSURGICAL SYSTEM 2670409 CDM 272 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price CONMED SUCTION IRRIGATOR ELECTROSURGICAL SYSTEM 2670409 CDM 272 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price "26720 Closed treatment of phalangeal shaft fx, proximal/middle phalanx w/o manipulation, each" 267201 CDM 521 RC 26720 HCPCS facility both 531 531 Gross Charge Type: NIHD_Clinic_Price 26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA TechFee 267202 CDM 450 RC facility both 788 788 Gross Charge Type: NIHD_Hosp_Profee_Price 26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA TechFee 267202 CDM 450 RC facility both 788 788 Gross Charge Type: NIHD_Hosp_Profee_Price "26720 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR T ProFee" 267203 CDM 982 RC 26720 HCPCS facility both 638 638 Gross Charge Type: NIHD_Hosp_Profee_Price "26720 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR T ProFee" 267203 CDM 982 RC 26720 HCPCS facility both 638 638 Gross Charge Type: NIHD_Hosp_Profee_Price "26725 Closed treatment of phalangeal shaft fracture, proximal/middle phalanx with manipulation each" 267251 CDM 521 RC 26725 HCPCS facility both 604 604 Gross Charge Type: NIHD_RHC_Price "26725 Closed treatment of phalangeal shaft fracture, proximal/middle phalanx with manipulation each" 267251 CDM 521 RC 26725 HCPCS facility both 604 604 Gross Charge Type: NIHD_Clinic_Price 26725 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA TechFee 267252 CDM 450 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 26725 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA TechFee 267252 CDM 450 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "26725 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR T ProFee" 267253 CDM 982 RC 26725 HCPCS facility both 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price "26725 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR T ProFee" 267253 CDM 982 RC 26725 HCPCS facility both 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price "26727 PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDD ProFee" 26727 CDM 982 RC 26727 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "26727 PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDD ProFee" 26727 CDM 982 RC 26727 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "26735 OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THU ProFee" 26735 CDM 982 RC 26735 HCPCS facility both 1261 1261 Gross Charge Type: NIHD_Hosp_Profee_Price "26735 OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THU ProFee" 26735 CDM 982 RC 26735 HCPCS facility both 1261 1261 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive VRS Glenoid Bone And Implant Model 2674479 CDM 278 RC facility both 2383 2383 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive VRS Glenoid Bone And Implant Model 2674479 CDM 278 RC facility both 2383 2383 Gross Charge Type: NIHD_Hosp_Profee_Price "26746 OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL ProFee" 26746 CDM 982 RC 26746 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "26746 OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL ProFee" 26746 CDM 982 RC 26746 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price 26755 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA TechFee 267551 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 26755 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA TechFee 267551 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "26755 CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITH MANIPULATION, EA ProFee" 267552 CDM 982 RC 26755 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "26755 CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITH MANIPULATION, EA ProFee" 267552 CDM 982 RC 26755 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "26765 OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, INCLUDES INTERNAL FIXAT ProFee" 26765 CDM 982 RC 26765 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "26765 OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, INCLUDES INTERNAL FIXAT ProFee" 26765 CDM 982 RC 26765 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price 26770 CLTX IPHAL JT DISLC W/MANJ 267701 CDM 450 RC facility both 575 575 Gross Charge Type: NIHD_Hosp_Profee_Price 26770 CLTX IPHAL JT DISLC W/MANJ 267701 CDM 450 RC facility both 575 575 Gross Charge Type: NIHD_Hosp_Profee_Price "26770 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; WITH ProFee" 267702 CDM 982 RC 26770 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "26770 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; WITH ProFee" 267702 CDM 982 RC 26770 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "26775 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; REQU ProFee" 26775 CDM 982 RC 26775 HCPCS facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price "26775 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; REQU ProFee" 26775 CDM 982 RC 26775 HCPCS facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price "26785 OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN ProFee" 26785 CDM 982 RC 26785 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price "26785 OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN ProFee" 26785 CDM 982 RC 26785 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price "26860 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; ProFee" 26860 CDM 982 RC 26860 HCPCS facility both 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price "26860 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; ProFee" 26860 CDM 982 RC 26860 HCPCS facility both 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price 26951 AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR TechFee 269511 CDM 450 RC facility both 2994 2994 Gross Charge Type: NIHD_Hosp_Profee_Price 26951 AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR TechFee 269511 CDM 450 RC facility both 2994 2994 Gross Charge Type: NIHD_Hosp_Profee_Price "26951 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLU ProFee" 269512 CDM 982 RC 26951 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "26951 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLU ProFee" 269512 CDM 982 RC 26951 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "26952 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLU ProFee" 26952 CDM 982 RC 26952 HCPCS facility both 1070 1070 Gross Charge Type: NIHD_Hosp_Profee_Price "26952 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLU ProFee" 26952 CDM 982 RC 26952 HCPCS facility both 1070 1070 Gross Charge Type: NIHD_Hosp_Profee_Price "26990 INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA ProFee" 26990 CDM 26990 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "26990 INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA ProFee" 26990 CDM 26990 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "27025 FASCIOTOMY, HIP OR THIGH, ANY TYPE ProFee" 27025 CDM 982 RC 27025 HCPCS facility both 1384 1384 Gross Charge Type: NIHD_Hosp_Profee_Price "27025 FASCIOTOMY, HIP OR THIGH, ANY TYPE ProFee" 27025 CDM 982 RC 27025 HCPCS facility both 1384 1384 Gross Charge Type: NIHD_Hosp_Profee_Price "27030 ARTHROTOMY, HIP, WITH DRAINAGE (EG, INFECTION) ProFee" 27030 CDM 982 RC 27030 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price "27030 ARTHROTOMY, HIP, WITH DRAINAGE (EG, INFECTION) ProFee" 27030 CDM 982 RC 27030 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price "27033 ARTHROTOMY, HIP, INCLUDING EXPLORATION OR REMOVAL OF LOOSE OR FOREIGN BODY ProFee" 27033 CDM 982 RC 27033 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "27033 ARTHROTOMY, HIP, INCLUDING EXPLORATION OR REMOVAL OF LOOSE OR FOREIGN BODY ProFee" 27033 CDM 982 RC 27033 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pelvis/Hip 270401 CDM 761 RC facility both TC 2147 2147 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pelvis/Hip 270401 CDM 761 RC facility both TC 2147 2147 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pelvis/Hip - Report 270402 CDM 982 RC 27040 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pelvis/Hip - Report 270402 CDM 982 RC 27040 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Soft Tissue Pelvis/Hip 270403 CDM 761 RC facility both TC 2147 2147 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Soft Tissue Pelvis/Hip 270403 CDM 761 RC facility both TC 2147 2147 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Soft Tissue Pelvis/Hip - Report 270404 CDM 982 RC 27040 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Soft Tissue Pelvis/Hip - Report 270404 CDM 982 RC 27040 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 27062 EXCISION; TROCHANTERIC BURSA OR CALCIFICATION ProFee 27062 CDM 982 RC 27062 HCPCS facility both 694 694 Gross Charge Type: NIHD_Hosp_Profee_Price 27062 EXCISION; TROCHANTERIC BURSA OR CALCIFICATION ProFee 27062 CDM 982 RC 27062 HCPCS facility both 694 694 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Left - Report 270692 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Left - Report 270692 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "27080 COCCYGECTOMY, PRIMARY ProFee" 27080 CDM 982 RC 27080 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "27080 COCCYGECTOMY, PRIMARY ProFee" 27080 CDM 982 RC 27080 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "27091 REMOVAL OF HIP PROSTHESIS; COMPLICATED, INCLUDING TOTAL HIP PROSTHESIS, METHYLMETHACRY ProFee" 27091 CDM 982 RC 27091 HCPCS facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price "27091 REMOVAL OF HIP PROSTHESIS; COMPLICATED, INCLUDING TOTAL HIP PROSTHESIS, METHYLMETHACRY ProFee" 27091 CDM 982 RC 27091 HCPCS facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Hip Left 270931 CDM 322 RC facility both TCLT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Hip Left 270931 CDM 322 RC facility both TCLT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Hip Right 270933 CDM 322 RC facility both TCRT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Hip Right 270933 CDM 322 RC facility both TCRT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Hip Right - Report 270935 CDM 982 RC 27093 HCPCS facility both 26RT 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Hip Right - Report 270935 CDM 982 RC 27093 HCPCS facility both 26RT 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Hip Left - Report 270936 CDM 982 RC 27093 HCPCS facility both 26LT 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Hip Left - Report 270936 CDM 982 RC 27093 HCPCS facility both 26LT 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Hip Left 270937 CDM 322 RC facility both TCLT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Hip Left 270937 CDM 322 RC facility both TCLT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Hip Right 270938 CDM 322 RC facility both TCRT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Hip Right 270938 CDM 322 RC facility both TCRT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection 270961 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection 270961 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Bilateral 2709612 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Bilateral 2709612 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Left 2709613 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Left 2709613 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Right 2709614 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Right 2709614 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Bilateral 2709615 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Bilateral 2709615 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Left 2709616 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Left 2709616 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Right 2709617 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Right 2709617 CDM 320 RC facility both TC 653 653 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection - Report 270962 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection - Report 270962 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Bilateral - Report 2709623 CDM 982 RC 27096 HCPCS facility both 2650 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Bilateral - Report 2709623 CDM 982 RC 27096 HCPCS facility both 2650 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Right - Report 2709624 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sacroiliac Joint Injection Right - Report 2709624 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Bilateral - Report 2709625 CDM 982 RC 27096 HCPCS facility both 2650 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Bilateral - Report 2709625 CDM 982 RC 27096 HCPCS facility both 2650 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Left - Report 2709626 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Left - Report 2709626 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Right - Report 2709627 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joint Injection Right - Report 2709627 CDM 982 RC 27096 HCPCS facility both 26 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "27130 ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHRO ProFee" 27130 CDM 982 RC 27130 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "27130 ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHRO ProFee" 27130 CDM 982 RC 27130 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "27132 CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAF ProFee" 27132 CDM 982 RC 27132 HCPCS facility both 3493 3493 Gross Charge Type: NIHD_Hosp_Profee_Price "27132 CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAF ProFee" 27132 CDM 982 RC 27132 HCPCS facility both 3493 3493 Gross Charge Type: NIHD_Hosp_Profee_Price "27134 REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT OR ALLO ProFee" 27134 CDM 982 RC 27134 HCPCS facility both 3992 3992 Gross Charge Type: NIHD_Hosp_Profee_Price "27134 REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT OR ALLO ProFee" 27134 CDM 982 RC 27134 HCPCS facility both 3992 3992 Gross Charge Type: NIHD_Hosp_Profee_Price "27138 REVISION OF TOTAL HIP ARTHROPLASTY; FEMORAL COMPONENT ONLY, WITH OR WITHOUT ALLOGRAFT ProFee" 27138 CDM 982 RC 27138 HCPCS facility both 3118 3118 Gross Charge Type: NIHD_Hosp_Profee_Price "27138 REVISION OF TOTAL HIP ARTHROPLASTY; FEMORAL COMPONENT ONLY, WITH OR WITHOUT ALLOGRAFT ProFee" 27138 CDM 982 RC 27138 HCPCS facility both 3118 3118 Gross Charge Type: NIHD_Hosp_Profee_Price "27176 TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE OR MULTIPLE PINNING, IN SITU ProFee" 27176 CDM 982 RC 27176 HCPCS facility both 1716 1716 Gross Charge Type: NIHD_Hosp_Profee_Price "27176 TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE OR MULTIPLE PINNING, IN SITU ProFee" 27176 CDM 982 RC 27176 HCPCS facility both 1716 1716 Gross Charge Type: NIHD_Hosp_Profee_Price "27187 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMET ProFee" 27187 CDM 975 RC 27187 HCPCS facility both 1725 1725 Gross Charge Type: NIHD_Hosp_Profee_Price "27187 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMET ProFee" 27187 CDM 975 RC 27187 HCPCS facility both 1725 1725 Gross Charge Type: NIHD_Hosp_Profee_Price "27197 CLOSED TREATMENT OF POSTERIOR PELVIC RING FRACTURE(S), DISLOCATION(S), DIASTASIS OR SU ProFee" 27197 CDM 982 RC 27197 HCPCS facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price "27197 CLOSED TREATMENT OF POSTERIOR PELVIC RING FRACTURE(S), DISLOCATION(S), DIASTASIS OR SU ProFee" 27197 CDM 982 RC 27197 HCPCS facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price "27197 Closed treatment of posterior pelvic ring fracture(s), dislocation(s), w/o manipulation" 271971 CDM 520 RC 27197 HCPCS facility both 206 206 Gross Charge Type: NIHD_RHC_Price "27197 Closed treatment of posterior pelvic ring fracture(s), dislocation(s), w/o manipulation" 271971 CDM 520 RC 27197 HCPCS facility both 206 206 Gross Charge Type: NIHD_Clinic_Price 27220 CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITHOUT MANIPULATION ProFee 27220 CDM 982 RC 27220 HCPCS facility both 987 987 Gross Charge Type: NIHD_Hosp_Profee_Price 27220 CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITHOUT MANIPULATION ProFee 27220 CDM 982 RC 27220 HCPCS facility both 987 987 Gross Charge Type: NIHD_Hosp_Profee_Price "27235 PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK ProFee" 27235 CDM 982 RC 27235 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "27235 PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK ProFee" 27235 CDM 982 RC 27235 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "27236 OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK, INTERNAL FIXATION OR PROSTHETI ProFee" 27236 CDM 982 RC 27236 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "27236 OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK, INTERNAL FIXATION OR PROSTHETI ProFee" 27236 CDM 982 RC 27236 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "27244 TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; ProFee" 27244 CDM 982 RC 27244 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "27244 TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; ProFee" 27244 CDM 982 RC 27244 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "27245 TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; ProFee" 27245 CDM 982 RC 27245 HCPCS facility both 2558 2558 Gross Charge Type: NIHD_Hosp_Profee_Price "27245 TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; ProFee" 27245 CDM 982 RC 27245 HCPCS facility both 2558 2558 Gross Charge Type: NIHD_Hosp_Profee_Price "27246 CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE, WITHOUT MANIPULATION ProFee" 27246 CDM 982 RC 27246 HCPCS facility both 680 680 Gross Charge Type: NIHD_Hosp_Profee_Price "27246 CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE, WITHOUT MANIPULATION ProFee" 27246 CDM 982 RC 27246 HCPCS facility both 680 680 Gross Charge Type: NIHD_Hosp_Profee_Price "27248 OPEN TREATMENT OF GREATER TROCHANTERIC FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERF ProFee" 27248 CDM 982 RC 27248 HCPCS facility both 1306 1306 Gross Charge Type: NIHD_Hosp_Profee_Price "27248 OPEN TREATMENT OF GREATER TROCHANTERIC FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERF ProFee" 27248 CDM 982 RC 27248 HCPCS facility both 1306 1306 Gross Charge Type: NIHD_Hosp_Profee_Price 27250 CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA TechFee 272501 CDM 450 RC facility both 768 768 Gross Charge Type: NIHD_Hosp_Profee_Price 27250 CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA TechFee 272501 CDM 450 RC facility both 768 768 Gross Charge Type: NIHD_Hosp_Profee_Price "27250 CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUT ANESTHESIA ProFee" 272502 CDM 982 RC 27250 HCPCS facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price "27250 CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUT ANESTHESIA ProFee" 272502 CDM 982 RC 27250 HCPCS facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price 27265 CLTX POST HIP ARTHRP DISLC W/O ANES TechFee 272651 CDM 450 RC facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 27265 CLTX POST HIP ARTHRP DISLC W/O ANES TechFee 272651 CDM 450 RC facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 27265 CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; WITHOUT ANESTHESIA ProFee 272652 CDM 982 RC 27265 HCPCS facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 27265 CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; WITHOUT ANESTHESIA ProFee 272652 CDM 982 RC 27265 HCPCS facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 27266 CLTX POST HIP ARTHRP DISLC REQ ANES TechFee 272661 CDM 450 RC facility both 3586 3586 Gross Charge Type: NIHD_Hosp_Profee_Price 27266 CLTX POST HIP ARTHRP DISLC REQ ANES TechFee 272661 CDM 450 RC facility both 3586 3586 Gross Charge Type: NIHD_Hosp_Profee_Price 27266 CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL A ProFee 272662 CDM 982 RC 27266 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price 27266 CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL A ProFee 272662 CDM 982 RC 27266 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "27275 MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA ProFee" 27275 CDM 982 RC 27275 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "27275 MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA ProFee" 27275 CDM 982 RC 27275 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "27299 UNLISTED PROCEDURE, PELVIS OR HIP JOINT ProFee" 27299 CDM 982 RC 27299 HCPCS facility both 1043 1043 Gross Charge Type: NIHD_Hosp_Profee_Price "27299 UNLISTED PROCEDURE, PELVIS OR HIP JOINT ProFee" 27299 CDM 982 RC 27299 HCPCS facility both 1043 1043 Gross Charge Type: NIHD_Hosp_Profee_Price "27301 Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region" 273011 CDM 521 RC 27301 HCPCS facility both 3777 3777 Gross Charge Type: NIHD_Clinic_Price "27301 INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION ProFee" 273012 CDM 982 RC 27301 HCPCS facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price "27301 INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION ProFee" 273012 CDM 982 RC 27301 HCPCS facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price "27310 ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY (EG, INFECTIO ProFee" 27310 CDM 982 RC 27310 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "27310 ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY (EG, INFECTIO ProFee" 27310 CDM 982 RC 27310 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "27334 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR OR POSTERIOR ProFee" 27334 CDM 982 RC 27334 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price "27334 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR OR POSTERIOR ProFee" 27334 CDM 982 RC 27334 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price "27335 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL AREA ProFee" 27335 CDM 982 RC 27335 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price "27335 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL AREA ProFee" 27335 CDM 982 RC 27335 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price "27337 EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 27337 CDM 982 RC 27337 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "27337 EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER ProFee" 27337 CDM 982 RC 27337 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "27340 EXCISION, PREPATELLAR BURSA ProFee" 27340 CDM 982 RC 27340 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "27340 EXCISION, PREPATELLAR BURSA ProFee" 27340 CDM 982 RC 27340 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Knee Right - Report 273691 CDM 960 RC 27369 HCPCS facility both 26RT 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Knee Right - Report 273691 CDM 960 RC 27369 HCPCS facility both 26RT 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Knee Left - Report 273692 CDM 960 RC 27369 HCPCS facility both 26LT 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Knee Left - Report 273692 CDM 960 RC 27369 HCPCS facility both 26LT 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Knee Left 273693 CDM 322 RC facility both TCLT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Knee Left 273693 CDM 322 RC facility both TCLT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Knee Right 273694 CDM 322 RC facility both TCRT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Injection Knee Right 273694 CDM 322 RC facility both TCRT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price "27372 REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA TechFee" 27372 CDM 982 RC 27372 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price "27372 REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA TechFee" 27372 CDM 982 RC 27372 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price 27380 SUTURE OF INFRAPATELLAR TENDON; PRIMARY ProFee 27380 CDM 982 RC 27380 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 27380 SUTURE OF INFRAPATELLAR TENDON; PRIMARY ProFee 27380 CDM 982 RC 27380 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 27385 SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY ProFee 27385 CDM 982 RC 27385 HCPCS facility both 1181 1181 Gross Charge Type: NIHD_Hosp_Profee_Price 27385 SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY ProFee 27385 CDM 982 RC 27385 HCPCS facility both 1181 1181 Gross Charge Type: NIHD_Hosp_Profee_Price 27393 LENGTHENING OF HAMSTRING TENDON; SINGLE TENDON ProFee 27393 CDM 975 RC 27393 HCPCS facility both 883 883 Gross Charge Type: NIHD_Hosp_Profee_Price 27393 LENGTHENING OF HAMSTRING TENDON; SINGLE TENDON ProFee 27393 CDM 975 RC 27393 HCPCS facility both 883 883 Gross Charge Type: NIHD_Hosp_Profee_Price 27415 OSTEOCHONDRAL ALLOGRAFT KNEE OPEN 27415 CDM 982 RC 27415 HCPCS facility both 616 616 Gross Charge Type: NIHD_Hosp_Profee_Price 27415 OSTEOCHONDRAL ALLOGRAFT KNEE OPEN 27415 CDM 982 RC 27415 HCPCS facility both 616 616 Gross Charge Type: NIHD_Hosp_Profee_Price RENOVARP® PARACENTESIS KIT 2741596 CDM facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price RENOVARP® PARACENTESIS KIT 2741596 CDM facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price "27416 OSTEOCHONDRAL AUTOGRAFT(S), KNEE, OPEN (EG, MOSAICPLASTY) (INCLUDES HARVESTING OF AUTO ProFee" 27416 CDM 982 RC 27416 HCPCS facility both 1705 1705 Gross Charge Type: NIHD_Hosp_Profee_Price "27416 OSTEOCHONDRAL AUTOGRAFT(S), KNEE, OPEN (EG, MOSAICPLASTY) (INCLUDES HARVESTING OF AUTO ProFee" 27416 CDM 982 RC 27416 HCPCS facility both 1705 1705 Gross Charge Type: NIHD_Hosp_Profee_Price "27418 ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE) ProFee" 27418 CDM 982 RC 27418 HCPCS facility both 1494 1494 Gross Charge Type: NIHD_Hosp_Profee_Price "27418 ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE) ProFee" 27418 CDM 982 RC 27418 HCPCS facility both 1494 1494 Gross Charge Type: NIHD_Hosp_Profee_Price "27420 RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE) ProFee" 27420 CDM 975 RC 27420 HCPCS facility both 1307 1307 Gross Charge Type: NIHD_Hosp_Profee_Price "27420 RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE) ProFee" 27420 CDM 975 RC 27420 HCPCS facility both 1307 1307 Gross Charge Type: NIHD_Hosp_Profee_Price 27422 RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCE ProFee 27422 CDM 982 RC 27422 HCPCS facility both 1296 1296 Gross Charge Type: NIHD_Hosp_Profee_Price 27422 RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCE ProFee 27422 CDM 982 RC 27422 HCPCS facility both 1296 1296 Gross Charge Type: NIHD_Hosp_Profee_Price "27425 LATERAL RETINACULAR RELEASE, OPEN ProFee" 27425 CDM 982 RC 27425 HCPCS facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price "27425 LATERAL RETINACULAR RELEASE, OPEN ProFee" 27425 CDM 982 RC 27425 HCPCS facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price "27427 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR ProFee" 27427 CDM 982 RC 27427 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "27427 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR ProFee" 27427 CDM 982 RC 27427 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "27428 Ligamentous reconstruction (augmentation), knee; intra-articular (open)" 27428 CDM 982 RC 27428 HCPCS facility both 2309 2309 Gross Charge Type: NIHD_Hosp_Profee_Price "27428 Ligamentous reconstruction (augmentation), knee; intra-articular (open)" 27428 CDM 982 RC 27428 HCPCS facility both 2309 2309 Gross Charge Type: NIHD_Hosp_Profee_Price "27430 QUADRICEPSPLASTY (EG, BENNETT OR THOMPSON TYPE) ProFee" 27430 CDM 982 RC 27430 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "27430 QUADRICEPSPLASTY (EG, BENNETT OR THOMPSON TYPE) ProFee" 27430 CDM 982 RC 27430 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "27447 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHO ProFee" 27447 CDM 982 RC 27447 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "27447 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHO ProFee" 27447 CDM 982 RC 27447 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "27455 OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES CORRECTIO ProFee" 27455 CDM 975 RC 27455 HCPCS facility both 1669 1669 Gross Charge Type: NIHD_Hosp_Profee_Price "27455 OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES CORRECTIO ProFee" 27455 CDM 975 RC 27455 HCPCS facility both 1669 1669 Gross Charge Type: NIHD_Hosp_Profee_Price "27457 OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES CORRECTIO ProFee" 27457 CDM 982 RC 27457 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "27457 OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OR OSTEOTOMY (INCLUDES CORRECTIO ProFee" 27457 CDM 982 RC 27457 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "27470 REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITHOUT GRAFT (EG, COMPR ProFee" 27470 CDM 982 RC 27470 HCPCS facility both 2372 2372 Gross Charge Type: NIHD_Hosp_Profee_Price "27470 REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITHOUT GRAFT (EG, COMPR ProFee" 27470 CDM 982 RC 27470 HCPCS facility both 2372 2372 Gross Charge Type: NIHD_Hosp_Profee_Price "27472 REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITH ILIAC OR OTHER AUTO ProFee" 27472 CDM 982 RC 27472 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "27472 REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD AND NECK; WITH ILIAC OR OTHER AUTO ProFee" 27472 CDM 982 RC 27472 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "27486 REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT ProFee" 27486 CDM 982 RC 27486 HCPCS facility both 2933 2933 Gross Charge Type: NIHD_Hosp_Profee_Price "27486 REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT ProFee" 27486 CDM 982 RC 27486 HCPCS facility both 2933 2933 Gross Charge Type: NIHD_Hosp_Profee_Price "27487 REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIB ProFee" 27487 CDM 982 RC 27487 HCPCS facility both 3680 3680 Gross Charge Type: NIHD_Hosp_Profee_Price "27487 REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIB ProFee" 27487 CDM 982 RC 27487 HCPCS facility both 3680 3680 Gross Charge Type: NIHD_Hosp_Profee_Price "27488 REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE PROSTHESIS, METHYLMETHACRYLATE WITH OR WIT ProFee" 27488 CDM 982 RC 27488 HCPCS facility both 2521 2521 Gross Charge Type: NIHD_Hosp_Profee_Price "27488 REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE PROSTHESIS, METHYLMETHACRYLATE WITH OR WIT ProFee" 27488 CDM 982 RC 27488 HCPCS facility both 2521 2521 Gross Charge Type: NIHD_Hosp_Profee_Price "27496 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, 1 COMPARTMENT (FLEXOR OR EXTENSOR OR ADDU ProFee" 27496 CDM 982 RC 27496 HCPCS facility both 1110 1110 Gross Charge Type: NIHD_Hosp_Profee_Price "27496 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, 1 COMPARTMENT (FLEXOR OR EXTENSOR OR ADDU ProFee" 27496 CDM 982 RC 27496 HCPCS facility both 1110 1110 Gross Charge Type: NIHD_Hosp_Profee_Price "27500 CLOSED TREAT FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION TechFee" 275001 CDM 450 RC facility both 1060 1060 Gross Charge Type: NIHD_Hosp_Profee_Price "27500 CLOSED TREAT FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION TechFee" 275001 CDM 450 RC facility both 1060 1060 Gross Charge Type: NIHD_Hosp_Profee_Price "27500 CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION ProFee" 275002 CDM 982 RC 27500 HCPCS facility both 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price "27500 CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION ProFee" 275002 CDM 982 RC 27500 HCPCS facility both 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 27502 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ TechFee 27502 CDM 450 RC facility both 2033 2033 Gross Charge Type: NIHD_Hosp_Profee_Price 27502 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ TechFee 27502 CDM 450 RC facility both 2033 2033 Gross Charge Type: NIHD_Hosp_Profee_Price 27502 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL T ProFee 275021 CDM 27502 HCPCS facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price 27502 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL T ProFee 275021 CDM 27502 HCPCS facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price "27506 OPEN TREATMENT OF FEMORAL SHAFT FRACTURE, WITH OR WITHOUT EXTERNAL FIXATION, WITH INSE ProFee" 27506 CDM 982 RC 27506 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "27506 OPEN TREATMENT OF FEMORAL SHAFT FRACTURE, WITH OR WITHOUT EXTERNAL FIXATION, WITH INSE ProFee" 27506 CDM 982 RC 27506 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "27507 OPEN TREATMENT OF FEMORAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE ProFee" 27507 CDM 982 RC 27507 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "27507 OPEN TREATMENT OF FEMORAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE ProFee" 27507 CDM 982 RC 27507 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "27509 PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL COND ProFee" 27509 CDM 982 RC 27509 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "27509 PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL COND ProFee" 27509 CDM 982 RC 27509 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "27510 CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITH MANI ProFee" 27510 CDM 982 RC 27510 HCPCS facility both 1237 1237 Gross Charge Type: NIHD_Hosp_Profee_Price "27510 CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITH MANI ProFee" 27510 CDM 982 RC 27510 HCPCS facility both 1237 1237 Gross Charge Type: NIHD_Hosp_Profee_Price 27511 OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERCONDYLA ProFee 27511 CDM 982 RC 27511 HCPCS facility both 2097 2097 Gross Charge Type: NIHD_Hosp_Profee_Price 27511 OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITHOUT INTERCONDYLA ProFee 27511 CDM 982 RC 27511 HCPCS facility both 2097 2097 Gross Charge Type: NIHD_Hosp_Profee_Price 27513 OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITH INTERCONDYLAR E ProFee 27513 CDM 982 RC 27513 HCPCS facility both 2558 2558 Gross Charge Type: NIHD_Hosp_Profee_Price 27513 OPEN TREATMENT OF FEMORAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE WITH INTERCONDYLAR E ProFee 27513 CDM 982 RC 27513 HCPCS facility both 2558 2558 Gross Charge Type: NIHD_Hosp_Profee_Price "27514 OPEN TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, INCLUDES IN ProFee" 27514 CDM 982 RC 27514 HCPCS facility both 1892 1892 Gross Charge Type: NIHD_Hosp_Profee_Price "27514 OPEN TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, INCLUDES IN ProFee" 27514 CDM 982 RC 27514 HCPCS facility both 1892 1892 Gross Charge Type: NIHD_Hosp_Profee_Price "27520 Closed treatment of patellar fracture, without manipulation" 27520 CDM 521 RC 27520 HCPCS facility both 1048 1048 Gross Charge Type: NIHD_Clinic_Price "27524 OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR COMPLETE ProFee" 27524 CDM 982 RC 27524 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "27524 OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR COMPLETE ProFee" 27524 CDM 982 RC 27524 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "27530 Closed treatment of tibial fracture, proximal (plateau); without manipulation" 275301 CDM 521 RC 27530 HCPCS facility both 1355 1355 Gross Charge Type: NIHD_Clinic_Price "27530 CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITHOUT MANIPULATION ProFee" 275302 CDM 982 RC 27530 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "27530 CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITHOUT MANIPULATION ProFee" 275302 CDM 982 RC 27530 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "27532 CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITH OR WITHOUT MANIPULATION, ProFee" 27532 CDM 982 RC 27532 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "27532 CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITH OR WITHOUT MANIPULATION, ProFee" 27532 CDM 982 RC 27532 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "27535 OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INTERNAL ProFee" 27535 CDM 982 RC 27535 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "27535 OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INTERNAL ProFee" 27535 CDM 982 RC 27535 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "27536 OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR WITHOUT INT ProFee" 27536 CDM 982 RC 27536 HCPCS facility both 2090 2090 Gross Charge Type: NIHD_Hosp_Profee_Price "27536 OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR WITHOUT INT ProFee" 27536 CDM 982 RC 27536 HCPCS facility both 2090 2090 Gross Charge Type: NIHD_Hosp_Profee_Price "27540 OPEN TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE, IN ProFee" 27540 CDM 982 RC 27540 HCPCS facility both 1418 1418 Gross Charge Type: NIHD_Hosp_Profee_Price "27540 OPEN TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE, IN ProFee" 27540 CDM 982 RC 27540 HCPCS facility both 1418 1418 Gross Charge Type: NIHD_Hosp_Profee_Price 27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA TechFee 27550_450 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA TechFee 27550_450 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA ProFee 27550_982 CDM 982 RC 27550 HCPCS facility both 727 727 Gross Charge Type: NIHD_Hosp_Profee_Price 27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA ProFee 27550_982 CDM 982 RC 27550 HCPCS facility both 727 727 Gross Charge Type: NIHD_Hosp_Profee_Price 27552 CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA ProFee 27552 CDM 982 RC 27552 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 27552 CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA ProFee 27552 CDM 982 RC 27552 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 27560 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA TechFee 275601 CDM 450 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 27560 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA TechFee 275601 CDM 450 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 27560 CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA ProFee 275602 CDM 982 RC 27560 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price 27560 CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA ProFee 275602 CDM 982 RC 27560 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "27566 OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUT PARTIAL OR TOTAL PATELLECTOMY ProFee" 27566 CDM 27566 HCPCS facility both 1339 1339 Gross Charge Type: NIHD_Hosp_Profee_Price "27566 OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUT PARTIAL OR TOTAL PATELLECTOMY ProFee" 27566 CDM 27566 HCPCS facility both 1339 1339 Gross Charge Type: NIHD_Hosp_Profee_Price 27570 MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION ProFee 27570 CDM 975 RC 27570 HCPCS facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price 27570 MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION ProFee 27570 CDM 975 RC 27570 HCPCS facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price "27590 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; ProFee" 27590 CDM 982 RC 27590 HCPCS facility both 1411 1411 Gross Charge Type: NIHD_Hosp_Profee_Price "27590 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; ProFee" 27590 CDM 982 RC 27590 HCPCS facility both 1411 1411 Gross Charge Type: NIHD_Hosp_Profee_Price 27598 DISARTICULATION AT KNEE ProFee 27598 CDM 982 RC 27598 HCPCS facility both 1205 1205 Gross Charge Type: NIHD_Hosp_Profee_Price 27598 DISARTICULATION AT KNEE ProFee 27598 CDM 982 RC 27598 HCPCS facility both 1205 1205 Gross Charge Type: NIHD_Hosp_Profee_Price "27602 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S) ProFee" 27602 CDM 982 RC 27602 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price "27602 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S) ProFee" 27602 CDM 982 RC 27602 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price "27603 INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA ProFee" 27603 CDM 982 RC 27603 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "27603 INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA ProFee" 27603 CDM 982 RC 27603 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "27606 TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA ProFee" 27606 CDM 982 RC 27606 HCPCS facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "27606 TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA ProFee" 27606 CDM 982 RC 27606 HCPCS facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "27610 ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY ProFee" 27610 CDM 982 RC 27610 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "27610 ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY ProFee" 27610 CDM 982 RC 27610 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "27618 Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm" 276181 CDM 521 RC 27618 HCPCS facility both 649 649 Gross Charge Type: NIHD_Clinic_Price "27618 EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; LESS THAN 3 CM ProFee" 276182 CDM 982 RC 27618 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "27618 EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; LESS THAN 3 CM ProFee" 276182 CDM 982 RC 27618 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "27619 Excision, tumor, soft tissue of leg or ankle area, subfascial; less than 5 cm" 276191 CDM 521 RC 27619 HCPCS facility both 936 936 Gross Charge Type: NIHD_Clinic_Price "27619 EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LES ProFee" 276192 CDM 982 RC 27619 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "27619 EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LES ProFee" 276192 CDM 982 RC 27619 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "27620 ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REM ProFee" 27620 CDM 982 RC 27620 HCPCS facility both 793 793 Gross Charge Type: NIHD_Hosp_Profee_Price "27620 ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REM ProFee" 27620 CDM 982 RC 27620 HCPCS facility both 793 793 Gross Charge Type: NIHD_Hosp_Profee_Price "27630 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKL ProFee" 27630 CDM 982 RC 27630 HCPCS facility both 668 668 Gross Charge Type: NIHD_Hosp_Profee_Price "27630 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKL ProFee" 27630 CDM 982 RC 27630 HCPCS facility both 668 668 Gross Charge Type: NIHD_Hosp_Profee_Price "27635 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; ProFee" 27635 CDM 982 RC 27635 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "27635 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; ProFee" 27635 CDM 982 RC 27635 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "27650 REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; ProFee" 27650 CDM 982 RC 27650 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "27650 REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; ProFee" 27650 CDM 982 RC 27650 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "27664 REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON ProFee" 27664 CDM 982 RC 27664 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "27664 REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON ProFee" 27664 CDM 982 RC 27664 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "27680 TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON ProFee" 27680 CDM 982 RC 27680 HCPCS facility both 779 779 Gross Charge Type: NIHD_Hosp_Profee_Price "27680 TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON ProFee" 27680 CDM 982 RC 27680 HCPCS facility both 779 779 Gross Charge Type: NIHD_Hosp_Profee_Price "27685 LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE) ProFee" 27685 CDM 982 RC 27685 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price "27685 LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE) ProFee" 27685 CDM 982 RC 27685 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price 27707 OSTEOTOMY; FIBULA ProFee 27707 CDM 982 RC 27707 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price 27707 OSTEOTOMY; FIBULA ProFee 27707 CDM 982 RC 27707 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price 27726 REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION ProFee 27726 CDM 982 RC 27726 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price 27726 REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION ProFee 27726 CDM 982 RC 27726 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price 27750 Closed treatment of tibial shaft fracture; without manipulation 277501 CDM 521 RC 27750 HCPCS facility both 1096 1096 Gross Charge Type: NIHD_Clinic_Price 27750 CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITHOUT ProFee 277502 CDM 982 RC 27750 HCPCS facility both 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price 27750 CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITHOUT ProFee 277502 CDM 982 RC 27750 HCPCS facility both 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price 27752 CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ TechFee 277521 CDM 450 RC facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price 27752 CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ TechFee 277521 CDM 450 RC facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price 27752 CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITH MAN ProFee 277522 CDM 982 RC 27752 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 27752 CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITH MAN ProFee 277522 CDM 982 RC 27752 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 27756 PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACT ProFee 27756 CDM 982 RC 27756 HCPCS facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price 27756 PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACT ProFee 27756 CDM 982 RC 27756 HCPCS facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "27758 OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE), WITH PLATE ProFee" 27758 CDM 982 RC 27758 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "27758 OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE), WITH PLATE ProFee" 27758 CDM 982 RC 27758 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price 27759 TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLAR ProFee 27759 CDM 982 RC 27759 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price 27759 TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLAR ProFee 27759 CDM 982 RC 27759 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price 27760 Closed treatment of medial malleolus fracture; without manipulation 27760 CDM 521 RC 27760 HCPCS facility both 1037 1037 Gross Charge Type: NIHD_Clinic_Price "27762 CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKIN ProFee" 27762 CDM 982 RC 27762 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "27762 CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKIN ProFee" 27762 CDM 982 RC 27762 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "27766 OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORME ProFee" 27766 CDM 982 RC 27766 HCPCS facility both 1106 1106 Gross Charge Type: NIHD_Hosp_Profee_Price "27766 OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORME ProFee" 27766 CDM 982 RC 27766 HCPCS facility both 1106 1106 Gross Charge Type: NIHD_Hosp_Profee_Price 27768 CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION ProFee 27768 CDM 982 RC 27768 HCPCS facility both 791 791 Gross Charge Type: NIHD_Hosp_Profee_Price 27768 CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION ProFee 27768 CDM 982 RC 27768 HCPCS facility both 791 791 Gross Charge Type: NIHD_Hosp_Profee_Price "27769 OPEN TREATMENT OF POSTERIOR MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFO ProFee" 27769 CDM 982 RC 27769 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "27769 OPEN TREATMENT OF POSTERIOR MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFO ProFee" 27769 CDM 982 RC 27769 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price 27781 CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION ProFee 27781 CDM 982 RC 27781 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price 27781 CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION ProFee 27781 CDM 982 RC 27781 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price 27781 CLTX PROX FIBULA/SHFT FX W/MANJ TechFee 277811 CDM 450 RC facility both 2353 2353 Gross Charge Type: NIHD_Hosp_Profee_Price 27781 CLTX PROX FIBULA/SHFT FX W/MANJ TechFee 277811 CDM 450 RC facility both 2353 2353 Gross Charge Type: NIHD_Hosp_Profee_Price 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation 27786 CDM 521 RC 27786 HCPCS facility both 922 922 Gross Charge Type: NIHD_Clinic_Price 27788 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH MANIPULATION ProFee 27788 CDM 982 RC 27788 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price 27788 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH MANIPULATION ProFee 27788 CDM 982 RC 27788 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price 27788 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ TechFee 277881 CDM 450 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price 27788 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ TechFee 277881 CDM 450 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "27792 OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXAT ProFee" 27792 CDM 982 RC 27792 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "27792 OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXAT ProFee" 27792 CDM 982 RC 27792 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price 27808 Closed treatment of bimalleolar ankle fracture; without manipulation 27808 CDM 521 RC 27808 HCPCS facility both 1037 1037 Gross Charge Type: NIHD_Clinic_Price 27810 Closed treatment of bimalleolar ankle fracture; with manipulation 278101 CDM 521 RC 27810 HCPCS facility both 2372 2372 Gross Charge Type: NIHD_Clinic_Price 27810 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ TechFee 278102 CDM 450 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 27810 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ TechFee 278102 CDM 450 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "27810 CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LA ProFee" 278103 CDM 982 RC 27810 HCPCS facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price "27810 CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LA ProFee" 278103 CDM 982 RC 27810 HCPCS facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price "27814 OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATE ProFee" 27814 CDM 982 RC 27814 HCPCS facility both 1623 1623 Gross Charge Type: NIHD_Hosp_Profee_Price "27814 OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATE ProFee" 27814 CDM 982 RC 27814 HCPCS facility both 1623 1623 Gross Charge Type: NIHD_Hosp_Profee_Price 27816 CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION ProFee 27816 CDM 982 RC 27816 HCPCS facility both 538 538 Gross Charge Type: NIHD_Hosp_Profee_Price 27816 CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION ProFee 27816 CDM 982 RC 27816 HCPCS facility both 538 538 Gross Charge Type: NIHD_Hosp_Profee_Price 27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION TechFee 278181 CDM 450 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price 27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION TechFee 278181 CDM 450 RC facility both 345 345 Gross Charge Type: NIHD_Hosp_Profee_Price 27818 CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION ProFee 278182 CDM 982 RC 27818 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 27818 CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION ProFee 278182 CDM 982 RC 27818 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "27822 OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR ProFee" 27822 CDM 982 RC 27822 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price "27822 OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR ProFee" 27822 CDM 982 RC 27822 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price "27823 OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR ProFee" 27823 CDM 982 RC 27823 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "27823 OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFOR ProFee" 27823 CDM 982 RC 27823 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "27824 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, ProFee" 27824 CDM 982 RC 27824 HCPCS facility both 1261 1261 Gross Charge Type: NIHD_Hosp_Profee_Price "27824 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, ProFee" 27824 CDM 982 RC 27824 HCPCS facility both 1261 1261 Gross Charge Type: NIHD_Hosp_Profee_Price "27824 Closed treatment of fracture of articular distal tibia, w/wo anesthesia; w/o manipulation" 278241 CDM 521 RC 27824 HCPCS facility both 495 495 Gross Charge Type: NIHD_RHC_Price "27824 Closed treatment of fracture of articular distal tibia, w/wo anesthesia; w/o manipulation" 278241 CDM 521 RC 27824 HCPCS facility both 495 495 Gross Charge Type: NIHD_Clinic_Price "27825 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, ProFee" 27825 CDM 982 RC 27825 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "27825 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, ProFee" 27825 CDM 982 RC 27825 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 27825 CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ TechFee 278251 CDM 450 RC facility both 3864 3864 Gross Charge Type: NIHD_Hosp_Profee_Price 27825 CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ TechFee 278251 CDM 450 RC facility both 3864 3864 Gross Charge Type: NIHD_Hosp_Profee_Price 27827 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA ProFee 27827 CDM 982 RC 27827 HCPCS facility both 2005 2005 Gross Charge Type: NIHD_Hosp_Profee_Price 27827 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA ProFee 27827 CDM 982 RC 27827 HCPCS facility both 2005 2005 Gross Charge Type: NIHD_Hosp_Profee_Price 27828 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA ProFee 27828 CDM 982 RC 27828 HCPCS facility both 2683 2683 Gross Charge Type: NIHD_Hosp_Profee_Price 27828 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA ProFee 27828 CDM 982 RC 27828 HCPCS facility both 2683 2683 Gross Charge Type: NIHD_Hosp_Profee_Price "27829 OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES INTERNA ProFee" 27829 CDM 982 RC 27829 HCPCS facility both 1461 1461 Gross Charge Type: NIHD_Hosp_Profee_Price "27829 OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES INTERNA ProFee" 27829 CDM 982 RC 27829 HCPCS facility both 1461 1461 Gross Charge Type: NIHD_Hosp_Profee_Price 27840 CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA TechFee 278401 CDM 450 RC facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price 27840 CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA TechFee 278401 CDM 450 RC facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price 27840 CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA ProFee 278402 CDM 982 RC 27840 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 27840 CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA ProFee 278402 CDM 982 RC 27840 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price "27842 CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING ANESTHESIA, WITH OR WITHOUT PERCUTANE ProFee" 27842 CDM 982 RC 27842 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "27842 CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING ANESTHESIA, WITH OR WITHOUT PERCUTANE ProFee" 27842 CDM 982 RC 27842 HCPCS facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price "27870 ARTHRODESIS, ANKLE, OPEN ProFee" 27870 CDM 982 RC 27870 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "27870 ARTHRODESIS, ANKLE, OPEN ProFee" 27870 CDM 982 RC 27870 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "27880 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; ProFee" 27880 CDM 982 RC 27880 HCPCS facility both 1566 1566 Gross Charge Type: NIHD_Hosp_Profee_Price "27880 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; ProFee" 27880 CDM 982 RC 27880 HCPCS facility both 1566 1566 Gross Charge Type: NIHD_Hosp_Profee_Price "27882 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; OPEN, CIRCULAR (GUILLOTINE) ProFee" 27882 CDM 982 RC 27882 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "27882 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; OPEN, CIRCULAR (GUILLOTINE) ProFee" 27882 CDM 982 RC 27882 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "27884 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDARY CLOSURE OR SCAR REVISION ProFee" 27884 CDM 982 RC 27884 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "27884 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDARY CLOSURE OR SCAR REVISION ProFee" 27884 CDM 982 RC 27884 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "27886 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; RE-AMPUTATION ProFee" 27886 CDM 27886 HCPCS facility both 1117 1117 Gross Charge Type: NIHD_Hosp_Profee_Price "27886 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; RE-AMPUTATION ProFee" 27886 CDM 27886 HCPCS facility both 1117 1117 Gross Charge Type: NIHD_Hosp_Profee_Price "27888 AMPUTATION, ANKLE, THROUGH MALLEOLI OF TIBIA AND FIBULA (EG, SYME, PIROGOFF TYPE PROCE ProFee" 27888 CDM 27888 HCPCS facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price "27888 AMPUTATION, ANKLE, THROUGH MALLEOLI OF TIBIA AND FIBULA (EG, SYME, PIROGOFF TYPE PROCE ProFee" 27888 CDM 27888 HCPCS facility both 950 950 Gross Charge Type: NIHD_Hosp_Profee_Price 27889 ANKLE DISARTICULATION ProFee 27889 CDM 982 RC 27889 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price 27889 ANKLE DISARTICULATION ProFee 27889 CDM 982 RC 27889 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price FETAL SCALP ELECTRODE APPLICATION CHARGE 27948_1 CDM 272 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price FETAL SCALP ELECTRODE APPLICATION CHARGE 27948_1 CDM 272 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price FHR Monitoring Method: -> Fetal spiral electrode 27948_2 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price FHR Monitoring Method: -> Fetal spiral electrode 27948_2 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price "28002 INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; S ProFee" 28002 CDM 982 RC 28002 HCPCS facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "28002 INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; S ProFee" 28002 CDM 982 RC 28002 HCPCS facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "28003 INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; M ProFee" 28003 CDM 28003 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "28003 INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; M ProFee" 28003 CDM 28003 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "28005 INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), FOOT ProFee" 28005 CDM 982 RC 28005 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "28005 INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), FOOT ProFee" 28005 CDM 982 RC 28005 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "28008 FASCIOTOMY, FOOT AND/OR TOE ProFee" 28008 CDM 982 RC 28008 HCPCS facility both 448 448 Gross Charge Type: NIHD_Hosp_Profee_Price "28008 FASCIOTOMY, FOOT AND/OR TOE ProFee" 28008 CDM 982 RC 28008 HCPCS facility both 448 448 Gross Charge Type: NIHD_Hosp_Profee_Price "28022 ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; META ProFee" 28022 CDM 982 RC 28022 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "28022 ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; META ProFee" 28022 CDM 982 RC 28022 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "28043 EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM ProFee" 28043 CDM 982 RC 28043 HCPCS facility both 470 470 Gross Charge Type: NIHD_Hosp_Profee_Price "28043 EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM ProFee" 28043 CDM 982 RC 28043 HCPCS facility both 470 470 Gross Charge Type: NIHD_Hosp_Profee_Price 28052 ARTHROTOMY WITH BIOPSY; METATARSOPHALANGEAL JOINT ProFee 28052 CDM 982 RC 28052 HCPCS facility both 538 538 Gross Charge Type: NIHD_Hosp_Profee_Price 28052 ARTHROTOMY WITH BIOPSY; METATARSOPHALANGEAL JOINT ProFee 28052 CDM 982 RC 28052 HCPCS facility both 538 538 Gross Charge Type: NIHD_Hosp_Profee_Price 28054 ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT ProFee 28054 CDM 982 RC 28054 HCPCS facility both 423 423 Gross Charge Type: NIHD_Hosp_Profee_Price 28054 ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT ProFee 28054 CDM 982 RC 28054 HCPCS facility both 423 423 Gross Charge Type: NIHD_Hosp_Profee_Price "28100 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; ProFee" 28100 CDM 982 RC 28100 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "28100 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; ProFee" 28100 CDM 982 RC 28100 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "28104 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS ProFee" 28104 CDM 982 RC 28104 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "28104 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS ProFee" 28104 CDM 982 RC 28104 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price AMBU PERFIT ADJ C-COLLAR INFANT/PED 2811060 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price AMBU PERFIT ADJ C-COLLAR INFANT/PED 2811060 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price "28122 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE ProFee" 28122 CDM 982 RC 28122 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "28122 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE ProFee" 28122 CDM 982 RC 28122 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "28124 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE ProFee" 28124 CDM 982 RC 28124 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "28124 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE ProFee" 28124 CDM 982 RC 28124 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "28160 HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALANX, EAC ProFee" 28160 CDM 975 RC 28160 HCPCS facility both 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price "28160 HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALANX, EAC ProFee" 28160 CDM 975 RC 28160 HCPCS facility both 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price 28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS TechFee 281901 CDM 450 RC facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price 28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS TechFee 281901 CDM 450 RC facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price "28190 REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS ProFee" 281902 CDM 982 RC 28190 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price "28190 REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS ProFee" 281902 CDM 982 RC 28190 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price "28190 Removal of foreign body, foot; subcutaneous" 281903 CDM 521 RC 28190 HCPCS facility both 382 382 Gross Charge Type: NIHD_RHC_Price "28190 Removal of foreign body, foot; subcutaneous" 281903 CDM 521 RC 28190 HCPCS facility both 382 382 Gross Charge Type: NIHD_Clinic_Price "28208 REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON ProFee" 28208 CDM 982 RC 28208 HCPCS facility both 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price "28208 REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON ProFee" 28208 CDM 982 RC 28208 HCPCS facility both 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price "28289 HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FI ProFee" 28289 CDM 982 RC 28289 HCPCS facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "28289 HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FI ProFee" 28289 CDM 982 RC 28289 HCPCS facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "28300 OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL ProFee" 28300 CDM 982 RC 28300 HCPCS facility both 1185 1185 Gross Charge Type: NIHD_Hosp_Profee_Price "28300 OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL ProFee" 28300 CDM 982 RC 28300 HCPCS facility both 1185 1185 Gross Charge Type: NIHD_Hosp_Profee_Price "28309 OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; ProFee" 28309 CDM 982 RC 28309 HCPCS facility both 2755 2755 Gross Charge Type: NIHD_Hosp_Profee_Price "28309 OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; ProFee" 28309 CDM 982 RC 28309 HCPCS facility both 2755 2755 Gross Charge Type: NIHD_Hosp_Profee_Price 28400 CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION ProFee 28400 CDM 982 RC 28400 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price 28400 CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION ProFee 28400 CDM 982 RC 28400 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price 28400 Closed treatment of calcaneal fracture; without manipulation 284001 CDM 521 RC 28400 HCPCS facility both 357 357 Gross Charge Type: NIHD_RHC_Price 28400 Closed treatment of calcaneal fracture; without manipulation 284001 CDM 521 RC 28400 HCPCS facility both 357 357 Gross Charge Type: NIHD_Clinic_Price 28405 CLOSED TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION ProFee 28405 CDM 982 RC 28405 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price 28405 CLOSED TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION ProFee 28405 CDM 982 RC 28405 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price 28405 Closed treatment of calcaneal fracture; with manipulation 284051 CDM 521 RC 28405 HCPCS facility both 702 702 Gross Charge Type: NIHD_Clinic_Price "28415 OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED; ProFee" 28415 CDM 982 RC 28415 HCPCS facility both 1972 1972 Gross Charge Type: NIHD_Hosp_Profee_Price "28415 OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED; ProFee" 28415 CDM 982 RC 28415 HCPCS facility both 1972 1972 Gross Charge Type: NIHD_Hosp_Profee_Price 28430 Closed treatment of talus fracture; without manipulation 284301 CDM 521 RC 28430 HCPCS facility both 431 431 Gross Charge Type: NIHD_RHC_Price 28430 Closed treatment of talus fracture; without manipulation 284301 CDM 521 RC 28430 HCPCS facility both 431 431 Gross Charge Type: NIHD_Clinic_Price 28435 CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION ProFee 28435 CDM 982 RC 28435 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 28435 CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION ProFee 28435 CDM 982 RC 28435 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price "28445 OPEN TREATMENT OF TALUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 28445 CDM 982 RC 28445 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "28445 OPEN TREATMENT OF TALUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 28445 CDM 982 RC 28445 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "28470 Closed treatment of metatarsal fracture; without manipulation, each" 28470 CDM 521 RC 28470 HCPCS facility both 614 614 Gross Charge Type: NIHD_Clinic_Price "28475 CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH TechFee" 284751 CDM 450 RC facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price "28475 CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH TechFee" 284751 CDM 450 RC facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price "28475 CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH ProFee" 284752 CDM 982 RC 28475 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price "28475 CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH ProFee" 284752 CDM 982 RC 28475 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price "28476 PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH ProFee" 28476 CDM 982 RC 28476 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price "28476 PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH ProFee" 28476 CDM 982 RC 28476 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price "28485 OPEN TREATMENT OF METATARSAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EAC ProFee" 28485 CDM 982 RC 28485 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "28485 OPEN TREATMENT OF METATARSAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EAC ProFee" 28485 CDM 982 RC 28485 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "28490 Closed treatment of fracture great toe, phalanx or phalanges; without manipulation" 28490 CDM 521 RC 28490 HCPCS facility both 221 221 Gross Charge Type: NIHD_RHC_Price "28490 Closed treatment of fracture great toe, phalanx or phalanges; without manipulation" 28490 CDM 521 RC 28490 HCPCS facility both 221 221 Gross Charge Type: NIHD_Clinic_Price "28495 CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION ProFee" 28495 CDM 982 RC 28495 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price "28495 CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION ProFee" 28495 CDM 982 RC 28495 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price "28505 OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATIO ProFee" 28505 CDM 982 RC 28505 HCPCS facility both 883 883 Gross Charge Type: NIHD_Hosp_Profee_Price "28505 OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATIO ProFee" 28505 CDM 982 RC 28505 HCPCS facility both 883 883 Gross Charge Type: NIHD_Hosp_Profee_Price "28510 Closed treatment of fracture, phalanx or phalanges, other than great toe w/o manipulation each" 285101 CDM 521 RC 28510 HCPCS facility both 333 333 Gross Charge Type: NIHD_Clinic_Price "28510 CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITHOUT MANI ProFee" 285102 CDM 982 RC 28510 HCPCS facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price "28510 CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITHOUT MANI ProFee" 285102 CDM 982 RC 28510 HCPCS facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price 28515 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ TechFee 285151 CDM 450 RC facility both 782 782 Gross Charge Type: NIHD_Hosp_Profee_Price 28515 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ TechFee 285151 CDM 450 RC facility both 782 782 Gross Charge Type: NIHD_Hosp_Profee_Price "28515 CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITH MANIPUL ProFee" 285152 CDM 982 RC 28515 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "28515 CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITH MANIPUL ProFee" 285152 CDM 982 RC 28515 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "28555 OPEN TREATMENT OF TARSAL BONE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 28555 CDM 982 RC 28555 HCPCS facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price "28555 OPEN TREATMENT OF TARSAL BONE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED ProFee" 28555 CDM 982 RC 28555 HCPCS facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price 28570 CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA ProFee 28570 CDM 982 RC 28570 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 28570 CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA ProFee 28570 CDM 982 RC 28570 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 28575 CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA ProFee 28575 CDM 982 RC 28575 HCPCS facility both 788 788 Gross Charge Type: NIHD_Hosp_Profee_Price 28575 CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA ProFee 28575 CDM 982 RC 28575 HCPCS facility both 788 788 Gross Charge Type: NIHD_Hosp_Profee_Price "28585 OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFO ProFee" 28585 CDM 982 RC 28585 HCPCS facility both 1848 1848 Gross Charge Type: NIHD_Hosp_Profee_Price "28585 OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFO ProFee" 28585 CDM 982 RC 28585 HCPCS facility both 1848 1848 Gross Charge Type: NIHD_Hosp_Profee_Price "28606 PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPULATION ProFee" 286061 CDM 982 RC 28606 HCPCS facility both 580 580 Gross Charge Type: NIHD_Hosp_Profee_Price "28606 PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPULATION ProFee" 286061 CDM 982 RC 28606 HCPCS facility both 580 580 Gross Charge Type: NIHD_Hosp_Profee_Price "28615 OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN ProFee" 28615 CDM 982 RC 28615 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "28615 OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN ProFee" 28615 CDM 982 RC 28615 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price 28630 CLTX METATARSOPHLNGL JT DISLC W/O ANES TechFee 286301 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 28630 CLTX METATARSOPHLNGL JT DISLC W/O ANES TechFee 286301 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 28630 CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA ProFee 286302 CDM 982 RC 28630 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 28630 CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA ProFee 286302 CDM 982 RC 28630 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 28635 CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA ProFee 28635 CDM 982 RC 28635 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price 28635 CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA ProFee 28635 CDM 982 RC 28635 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price 28660 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA ProFee 28660 CDM 982 RC 28660 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 28660 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA ProFee 28660 CDM 982 RC 28660 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 28665 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA ProFee 28665 CDM 982 RC 28665 HCPCS facility both 221 221 Gross Charge Type: NIHD_Hosp_Profee_Price 28665 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA ProFee 28665 CDM 982 RC 28665 HCPCS facility both 221 221 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER GUIDE PIN 0.3 X 75 MM 2870001 CDM 272 RC facility both 548 548 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER GUIDE PIN 0.3 X 75 MM 2870001 CDM 272 RC facility both 548 548 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER PERFORM REVERSED GLENOID FULLWEDGE BASEPLATE 15DEG DIA 29MM 2870002 CDM 278 RC facility both 10709 10709 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER PERFORM REVERSED GLENOID FULLWEDGE BASEPLATE 15DEG DIA 29MM 2870002 CDM 278 RC facility both 10709 10709 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER FLEX SHOULDER SYS REVERSE INSERT 39MM 6TH B 12.5DEG 2870006 CDM 278 RC facility both 4389 4389 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER FLEX SHOULDER SYS REVERSE INSERT 39MM 6TH B 12.5DEG 2870006 CDM 278 RC facility both 4389 4389 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER FLEX SHOULDER PTC HUMERAL STEM 7 B X 90MM X132.5 DEG 2870007 CDM 278 RC facility both 15721 15721 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER FLEX SHOULDER PTC HUMERAL STEM 7 B X 90MM X132.5 DEG 2870007 CDM 278 RC facility both 15721 15721 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER CANNULATED C0CR REVERSED GLENOSPHERE 39 MM 2870008 CDM 278 RC facility both 12251 12251 Gross Charge Type: NIHD_Hosp_Profee_Price TORNIER CANNULATED C0CR REVERSED GLENOSPHERE 39 MM 2870008 CDM 278 RC facility both 12251 12251 Gross Charge Type: NIHD_Hosp_Profee_Price "28805 AMPUTATION, FOOT; TRANSMETATARSAL ProFee" 28805 CDM 982 RC 28805 HCPCS facility both 1473 1473 Gross Charge Type: NIHD_Hosp_Profee_Price "28805 AMPUTATION, FOOT; TRANSMETATARSAL ProFee" 28805 CDM 982 RC 28805 HCPCS facility both 1473 1473 Gross Charge Type: NIHD_Hosp_Profee_Price "28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE ProFee" 28810 CDM 982 RC 28810 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE ProFee" 28810 CDM 982 RC 28810 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "28820 AMPUTATION, TOE; METATARSOPHALANGEAL JOINT ProFee" 28820 CDM 982 RC 28820 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "28820 AMPUTATION, TOE; METATARSOPHALANGEAL JOINT ProFee" 28820 CDM 982 RC 28820 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "28825 AMPUTATION, TOE; INTERPHALANGEAL JOINT ProFee" 28825 CDM 982 RC 28825 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price "28825 AMPUTATION, TOE; INTERPHALANGEAL JOINT ProFee" 28825 CDM 982 RC 28825 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price "28899 UNLISTED PROCEDURE, FOOT OR TOES ProFee" 28899 CDM 982 RC 28899 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "28899 UNLISTED PROCEDURE, FOOT OR TOES ProFee" 28899 CDM 982 RC 28899 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "29065 Application, cast; shoulder to hand (long arm)" 29065 CDM 521 RC 29065 HCPCS facility both 389 389 Gross Charge Type: NIHD_Clinic_Price "29075 Application, cast; elbow to finger (short arm)" 290751 CDM 521 RC 29075 HCPCS facility both 302 302 Gross Charge Type: NIHD_Clinic_Price 29075 APPLICATION CAST ELBOW FINGER SHORT ARM TechFee 290752 CDM 450 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 29075 APPLICATION CAST ELBOW FINGER SHORT ARM TechFee 290752 CDM 450 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price "29075 APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM) ProFee" 290753 CDM 982 RC 29075 HCPCS facility both 300 300 Gross Charge Type: NIHD_Hosp_Profee_Price "29075 APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM) ProFee" 290753 CDM 982 RC 29075 HCPCS facility both 300 300 Gross Charge Type: NIHD_Hosp_Profee_Price "29085 APPLICATION, CAST; HAND AND LOWER FOREARM (GAUNTLET) ProFee" 29085 CDM 982 RC 29085 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "29085 APPLICATION, CAST; HAND AND LOWER FOREARM (GAUNTLET) ProFee" 29085 CDM 982 RC 29085 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 29105 Application of long arm splint (shoulder to hand) 291051 CDM 521 RC 29105 HCPCS facility both 247 247 Gross Charge Type: NIHD_RHC_Price 29105 Application of long arm splint (shoulder to hand) 291051 CDM 521 RC 29105 HCPCS facility both 247 247 Gross Charge Type: NIHD_Clinic_Price 29105 ER LONG ARM SPLINT (SHOULDER TO HAND) 291052 CDM 450 RC facility both 1237 1237 Gross Charge Type: NIHD_Hosp_Profee_Price 29105 ER LONG ARM SPLINT (SHOULDER TO HAND) 291052 CDM 450 RC facility both 1237 1237 Gross Charge Type: NIHD_Hosp_Profee_Price 29105 APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND) ProFee 291053 CDM 982 RC 29105 HCPCS facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price 29105 APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND) ProFee 291053 CDM 982 RC 29105 HCPCS facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price 29125 Application of short arm splint (forearm to hand); static 291251 CDM 521 RC 29125 HCPCS facility both 238 238 Gross Charge Type: NIHD_RHC_Price 29125 Application of short arm splint (forearm to hand); static 291251 CDM 521 RC 29125 HCPCS facility both 212 212 Gross Charge Type: NIHD_Clinic_Price 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee 291252 CDM 450 RC facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee 291252 CDM 450 RC facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC ProFee 291253 CDM 982 RC 29125 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC ProFee 291253 CDM 982 RC 29125 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 29125-Short Arm 291254 CDM 450 RC facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 29125-Short Arm 291254 CDM 450 RC facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 29130 Application of finger splint; static 291302 CDM 521 RC 29130 HCPCS facility both 141 141 Gross Charge Type: NIHD_Clinic_Price 29130 APPLICATION OF FINGER SPLINT; STATIC ProFee 291303 CDM 982 RC 29130 HCPCS facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 29130 APPLICATION OF FINGER SPLINT; STATIC ProFee 291303 CDM 982 RC 29130 HCPCS facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 29130 APPLICATION FINGER SPLINT STATIC 291304 CDM 450 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price 29130 APPLICATION FINGER SPLINT STATIC 291304 CDM 450 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price 29345 Application of long leg cast (thigh to toes); 293451 CDM 521 RC 29345 HCPCS facility both 338 338 Gross Charge Type: NIHD_Clinic_Price 29345 APPLICATION OF LONG LEG CAST (THIGH TO TOES); ProFee 293452 CDM 982 RC 29345 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 29345 APPLICATION OF LONG LEG CAST (THIGH TO TOES); ProFee 293452 CDM 982 RC 29345 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 29405 Application of short leg cast (below knee to toes); 294051 CDM 521 RC 29405 HCPCS facility both 282 282 Gross Charge Type: NIHD_Clinic_Price 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); ProFee 294052 CDM 982 RC 29405 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); ProFee 294052 CDM 982 RC 29405 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 29425 Application of short leg cast (below knee to toes); walking or ambulatory type 29425 CDM 521 RC 29425 HCPCS facility both 347 347 Gross Charge Type: NIHD_Clinic_Price MELKER CATHETER SET CRICOTHYROTOMY 2943200 CDM 272 RC facility both 866 866 Gross Charge Type: NIHD_Hosp_Profee_Price MELKER CATHETER SET CRICOTHYROTOMY 2943200 CDM 272 RC facility both 866 866 Gross Charge Type: NIHD_Hosp_Profee_Price "29450 Application of clubfoot cast with molding or manipulation, long or short leg" 29450 CDM 521 RC 29450 HCPCS facility both 198 198 Gross Charge Type: NIHD_Clinic_Price 29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee 295053 CDM 450 RC facility both 1412 1412 Gross Charge Type: NIHD_Hosp_Profee_Price 29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee 295053 CDM 450 RC facility both 1412 1412 Gross Charge Type: NIHD_Hosp_Profee_Price 29505 APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES) ProFee 295054 CDM 982 RC 29505 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 29505 APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES) ProFee 295054 CDM 982 RC 29505 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 29515 Application of short leg splint (calf to foot) 295151 CDM 521 RC 29515 HCPCS facility both 285 285 Gross Charge Type: NIHD_RHC_Price 29515 Application of short leg splint (calf to foot) 295151 CDM 521 RC 29515 HCPCS facility both 162 162 Gross Charge Type: NIHD_Clinic_Price 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee 295152 CDM 450 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee 295152 CDM 450 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) ProFee 295153 CDM 982 RC 29515 HCPCS facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) ProFee 295153 CDM 982 RC 29515 HCPCS facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 29530 Strapping; knee 29530 CDM 521 RC 29530 HCPCS facility both 112 112 Gross Charge Type: NIHD_Clinic_Price 29540 Strapping; ankle and/or foot 29540 CDM 521 RC 29540 HCPCS facility both 102 102 Gross Charge Type: NIHD_RHC_Price 29550 Strapping/Toes 295501 CDM 521 RC 29550 HCPCS facility both 111 111 Gross Charge Type: NIHD_Clinic_Price 29550 STRAPPING TOES TechFee 295502 CDM 450 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 29550 STRAPPING TOES TechFee 295502 CDM 450 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 29550 STRAPPING; TOES ProFee 295503 CDM 982 RC 29550 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 29550 STRAPPING; TOES ProFee 295503 CDM 982 RC 29550 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 29580 Strapping; Unna boot 295801 CDM 521 RC 29580 HCPCS facility both 311 311 Gross Charge Type: NIHD_RHC_Price 29580 Strapping; Unna boot 295801 CDM 521 RC 29580 HCPCS facility both 125 125 Gross Charge Type: NIHD_Clinic_Price Unna boot Uni and Bil Charge 295802 CDM 960 RC 29580 HCPCS facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price Unna boot Uni and Bil Charge 295802 CDM 960 RC 29580 HCPCS facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price 29580 STRAPPING; UNNA BOOT ProFee 295803 CDM 982 RC 29580 HCPCS facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price 29580 STRAPPING; UNNA BOOT ProFee 295803 CDM 982 RC 29580 HCPCS facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price 29580 APPL OF UNNA BOOT 295804 CDM 761 RC facility both 470 470 Gross Charge Type: NIHD_Hosp_Profee_Price 29580 APPL OF UNNA BOOT 295804 CDM 761 RC facility both 470 470 Gross Charge Type: NIHD_Hosp_Profee_Price Vascular Compression 29581 CDM 761 RC facility both 516 516 Gross Charge Type: NIHD_Hosp_Profee_Price Vascular Compression 29581 CDM 761 RC facility both 516 516 Gross Charge Type: NIHD_Hosp_Profee_Price 29581 Application Multilayer Compression System; Below Knee 295811 CDM 521 RC 29581 HCPCS facility both 159 159 Gross Charge Type: NIHD_RHC_Price 29581 Application Multilayer Compression System; Below Knee 295811 CDM 521 RC 29581 HCPCS facility both 159 159 Gross Charge Type: NIHD_Clinic_Price PT Lymphedema Wrap below Knee Charge 295812 CDM 420 RC facility both GP 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price PT Lymphedema Wrap below Knee Charge 295812 CDM 420 RC facility both GP 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 29581 APLY MULTILAY COMP L WR LEG SEP/DIST CHARGE 295813 CDM 420 RC facility both GP 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 29581 APLY MULTILAY COMP L WR LEG SEP/DIST CHARGE 295813 CDM 420 RC facility both GP 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 29581 APPLY MULTLAY COMPRS LR LEG CHARGE 295814 CDM 420 RC facility both GP 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 29581 APPLY MULTLAY COMPRS LR LEG CHARGE 295814 CDM 420 RC facility both GP 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price "29581 APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; LEG (BELOW KNEE), INCLUDING ANKLE AND F ProFee" 295815 CDM 982 RC 29581 HCPCS facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price "29581 APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; LEG (BELOW KNEE), INCLUDING ANKLE AND F ProFee" 295815 CDM 982 RC 29581 HCPCS facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price "29700 Removal or bivalving; gauntlet, boot or body cast" 29700 CDM 521 RC 29700 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price "29700 Removal or bivalving; gauntlet, boot or body cast" 29700 CDM 521 RC 29700 HCPCS facility both 96 96 Gross Charge Type: NIHD_Clinic_Price 29705 Removal or bivalving; full arm or full leg cast 29705 CDM 521 RC 29705 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price 29705 Removal or bivalving; full arm or full leg cast 29705 CDM 521 RC 29705 HCPCS facility both 96 96 Gross Charge Type: NIHD_Clinic_Price "29710 Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc." 29710 CDM 521 RC 29710 HCPCS facility both 186 186 Gross Charge Type: NIHD_RHC_Price "29710 Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc." 29710 CDM 521 RC 29710 HCPCS facility both 186 186 Gross Charge Type: NIHD_Clinic_Price "29805 ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE ProFee" 29805 CDM 982 RC 29805 HCPCS facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "29805 ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE ProFee" 29805 CDM 982 RC 29805 HCPCS facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "29806 ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY ProFee" 29806 CDM 982 RC 29806 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price "29806 ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY ProFee" 29806 CDM 982 RC 29806 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price "29807 ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION ProFee" 29807 CDM 982 RC 29807 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "29807 ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION ProFee" 29807 CDM 982 RC 29807 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "29819 ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY ProFee" 29819 CDM 982 RC 29819 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price "29819 ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY ProFee" 29819 CDM 982 RC 29819 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price "29820 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL ProFee" 29820 CDM 982 RC 29820 HCPCS facility both 940 940 Gross Charge Type: NIHD_Hosp_Profee_Price "29820 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL ProFee" 29820 CDM 982 RC 29820 HCPCS facility both 940 940 Gross Charge Type: NIHD_Hosp_Profee_Price "29821 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE ProFee" 29821 CDM 982 RC 29821 HCPCS facility both 1043 1043 Gross Charge Type: NIHD_Hosp_Profee_Price "29821 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE ProFee" 29821 CDM 982 RC 29821 HCPCS facility both 1043 1043 Gross Charge Type: NIHD_Hosp_Profee_Price "29822 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED ProFee" 29822 CDM 982 RC 29822 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "29822 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED ProFee" 29822 CDM 982 RC 29822 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "29823 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE ProFee" 29823 CDM 982 RC 29823 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "29823 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE ProFee" 29823 CDM 982 RC 29823 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "29824 ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURF ProFee" 29824 CDM 982 RC 29824 HCPCS facility both 1424 1424 Gross Charge Type: NIHD_Hosp_Profee_Price "29824 ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURF ProFee" 29824 CDM 982 RC 29824 HCPCS facility both 1424 1424 Gross Charge Type: NIHD_Hosp_Profee_Price "29825 ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR WITHOU ProFee" 29825 CDM 982 RC 29825 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price "29825 ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR WITHOU ProFee" 29825 CDM 982 RC 29825 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price "29826 ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROM ProFee" 29826 CDM 982 RC 29826 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "29826 ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROM ProFee" 29826 CDM 982 RC 29826 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "29827 ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR ProFee" 29827 CDM 982 RC 29827 HCPCS facility both 2247 2247 Gross Charge Type: NIHD_Hosp_Profee_Price "29827 ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR ProFee" 29827 CDM 982 RC 29827 HCPCS facility both 2247 2247 Gross Charge Type: NIHD_Hosp_Profee_Price "29828 ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS ProFee" 29828 CDM 982 RC 29828 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "29828 ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS ProFee" 29828 CDM 982 RC 29828 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price "29855 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, ProFee" 29855 CDM 982 RC 29855 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "29855 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, ProFee" 29855 CDM 982 RC 29855 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "29856 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, I ProFee" 29856 CDM 982 RC 29856 HCPCS facility both 1835 1835 Gross Charge Type: NIHD_Hosp_Profee_Price "29856 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, I ProFee" 29856 CDM 982 RC 29856 HCPCS facility both 1835 1835 Gross Charge Type: NIHD_Hosp_Profee_Price "29861 ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY ProFee" 29861 CDM 982 RC 29861 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "29861 ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY ProFee" 29861 CDM 982 RC 29861 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "29862 ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPL ProFee" 29862 CDM 29862 HCPCS facility both 1235 1235 Gross Charge Type: NIHD_Hosp_Profee_Price "29862 ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPL ProFee" 29862 CDM 29862 HCPCS facility both 1235 1235 Gross Charge Type: NIHD_Hosp_Profee_Price "29870 ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE) ProFee" 29870 CDM 982 RC 29870 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "29870 ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE) ProFee" 29870 CDM 982 RC 29870 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "29871 ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE ProFee" 29871 CDM 982 RC 29871 HCPCS facility both 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price "29871 ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE ProFee" 29871 CDM 982 RC 29871 HCPCS facility both 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price "29873 ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE ProFee" 29873 CDM 982 RC 29873 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "29873 ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE ProFee" 29873 CDM 982 RC 29873 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "29874 ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTEOCHOND ProFee" 29874 CDM 982 RC 29874 HCPCS facility both 1137 1137 Gross Charge Type: NIHD_Hosp_Profee_Price "29874 ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTEOCHOND ProFee" 29874 CDM 982 RC 29874 HCPCS facility both 1137 1137 Gross Charge Type: NIHD_Hosp_Profee_Price "29875 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPA ProFee" 29875 CDM 982 RC 29875 HCPCS facility both 1017 1017 Gross Charge Type: NIHD_Hosp_Profee_Price "29875 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPA ProFee" 29875 CDM 982 RC 29875 HCPCS facility both 1017 1017 Gross Charge Type: NIHD_Hosp_Profee_Price "29876 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, 2 OR MORE COMPARTMENTS (EG, MEDIAL OR ProFee" 29876 CDM 982 RC 29876 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "29876 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, 2 OR MORE COMPARTMENTS (EG, MEDIAL OR ProFee" 29876 CDM 982 RC 29876 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "29877 ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY ProFee" 29877 CDM 982 RC 29877 HCPCS facility both 1174 1174 Gross Charge Type: NIHD_Hosp_Profee_Price "29877 ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY ProFee" 29877 CDM 982 RC 29877 HCPCS facility both 1174 1174 Gross Charge Type: NIHD_Hosp_Profee_Price "29879 ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECES ProFee" 29879 CDM 982 RC 29879 HCPCS facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price "29879 ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECES ProFee" 29879 CDM 982 RC 29879 HCPCS facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price "29880 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENI ProFee" 29880 CDM 982 RC 29880 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "29880 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENI ProFee" 29880 CDM 982 RC 29880 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENIS ProFee" 29881 CDM 982 RC 29881 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENIS ProFee" 29881 CDM 982 RC 29881 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "29882 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL) ProFee" 29882 CDM 982 RC 29882 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "29882 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL) ProFee" 29882 CDM 982 RC 29882 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "29887 ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION WITH ProFee" 29887 CDM 975 RC 29887 HCPCS facility both 1318 1318 Gross Charge Type: NIHD_Hosp_Profee_Price "29887 ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION WITH ProFee" 29887 CDM 975 RC 29887 HCPCS facility both 1318 1318 Gross Charge Type: NIHD_Hosp_Profee_Price 29888 ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTIO ProFee 29888 CDM 982 RC 29888 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price 29888 ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTIO ProFee 29888 CDM 982 RC 29888 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price 29889 ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTI ProFee 29889 CDM 982 RC 29889 HCPCS facility both 2247 2247 Gross Charge Type: NIHD_Hosp_Profee_Price 29889 ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTI ProFee 29889 CDM 982 RC 29889 HCPCS facility both 2247 2247 Gross Charge Type: NIHD_Hosp_Profee_Price "29891 ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, ProFee" 29891 CDM 982 RC 29891 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "29891 ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, ProFee" 29891 CDM 982 RC 29891 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "29894 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOS ProFee" 29894 CDM 982 RC 29894 HCPCS facility both 880 880 Gross Charge Type: NIHD_Hosp_Profee_Price "29894 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOS ProFee" 29894 CDM 982 RC 29894 HCPCS facility both 880 880 Gross Charge Type: NIHD_Hosp_Profee_Price "29895 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL ProFee" 29895 CDM 982 RC 29895 HCPCS facility both 822 822 Gross Charge Type: NIHD_Hosp_Profee_Price "29895 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL ProFee" 29895 CDM 982 RC 29895 HCPCS facility both 822 822 Gross Charge Type: NIHD_Hosp_Profee_Price "29897 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED ProFee" 29897 CDM 982 RC 29897 HCPCS facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "29897 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED ProFee" 29897 CDM 982 RC 29897 HCPCS facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "29898 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSI ProFee" 29898 CDM 982 RC 29898 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "29898 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSI ProFee" 29898 CDM 982 RC 29898 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "29915 ARTHROSCOPY, HIP, SURGICAL; WITH ACETABULOPLASTY (IE, TREATMENT OF PINCER LESION) ProFee" 29915 CDM 982 RC 29915 HCPCS facility both 2022 2022 Gross Charge Type: NIHD_Hosp_Profee_Price "29915 ARTHROSCOPY, HIP, SURGICAL; WITH ACETABULOPLASTY (IE, TREATMENT OF PINCER LESION) ProFee" 29915 CDM 982 RC 29915 HCPCS facility both 2022 2022 Gross Charge Type: NIHD_Hosp_Profee_Price "29999 UNLISTED PROCEDURE, ARTHROSCOPY ProFee" 29999 CDM 982 RC 29999 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "29999 UNLISTED PROCEDURE, ARTHROSCOPY ProFee" 29999 CDM 982 RC 29999 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price 30300 REMOVAL NASAL FOREIGN BODY-ER SERV PROCE 303001 CDM 450 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 30300 REMOVAL NASAL FOREIGN BODY-ER SERV PROCE 303001 CDM 450 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price "30300 REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE ProFee" 303002 CDM 982 RC 30300 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "30300 REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE ProFee" 303002 CDM 982 RC 30300 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "30400 RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP ProFee" 30400 CDM 982 RC 30400 HCPCS facility both 2140 2140 Gross Charge Type: NIHD_Hosp_Profee_Price "30400 RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP ProFee" 30400 CDM 982 RC 30400 HCPCS facility both 2140 2140 Gross Charge Type: NIHD_Hosp_Profee_Price "30420 RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR ProFee" 30420 CDM 982 RC 30420 HCPCS facility both 2497 2497 Gross Charge Type: NIHD_Hosp_Profee_Price "30420 RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR ProFee" 30420 CDM 982 RC 30420 HCPCS facility both 2497 2497 Gross Charge Type: NIHD_Hosp_Profee_Price "30520 SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR R ProFee" 30520 CDM 982 RC 30520 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "30520 SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR R ProFee" 30520 CDM 982 RC 30520 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price 30630 REPAIR NASAL SEPTAL PERFORATIONS ProFee 30630 CDM 982 RC 30630 HCPCS facility both 1147 1147 Gross Charge Type: NIHD_Hosp_Profee_Price 30630 REPAIR NASAL SEPTAL PERFORATIONS ProFee 30630 CDM 982 RC 30630 HCPCS facility both 1147 1147 Gross Charge Type: NIHD_Hosp_Profee_Price 30901 CONTROL ANT. NASAL HEMORRHAGE- ER SERV P 309011 CDM 450 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 30901 CONTROL ANT. NASAL HEMORRHAGE- ER SERV P 309011 CDM 450 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "30901 CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD ProFee" 309012 CDM 982 RC 30901 HCPCS facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "30901 CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD ProFee" 309012 CDM 982 RC 30901 HCPCS facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "30901 Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method" 309013 CDM 521 RC 30901 HCPCS facility both 84 84 Gross Charge Type: NIHD_RHC_Price "30901 Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method" 309013 CDM 521 RC 30901 HCPCS facility both 84 84 Gross Charge Type: NIHD_Clinic_Price "30903 CONTROL ANT. NASAL HEMOR,COMP- ER SERV P" 309031 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "30903 CONTROL ANT. NASAL HEMOR,COMP- ER SERV P" 309031 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "30903 CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY MET ProFee" 309032 CDM 982 RC 30903 HCPCS facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price "30903 CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY MET ProFee" 309032 CDM 982 RC 30903 HCPCS facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price 30905 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST TechFee 309051 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 30905 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST TechFee 309051 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "30905 CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY ME ProFee" 309052 CDM 982 RC 30905 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price "30905 CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY ME ProFee" 309052 CDM 982 RC 30905 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price "30906 CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY ME ProFee" 30906 CDM 982 RC 30906 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "30906 CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY ME ProFee" 30906 CDM 982 RC 30906 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price BASIC EVALUATION PACK (2 LEADS) 3092010 CDM 272 RC facility both 315 315 Gross Charge Type: NIHD_Hosp_Profee_Price BASIC EVALUATION PACK (2 LEADS) 3092010 CDM 272 RC facility both 315 315 Gross Charge Type: NIHD_Hosp_Profee_Price Medtronic Versatex 15 cm x 15 cm Monofilament Mesh 3115100 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price Medtronic Versatex 15 cm x 15 cm Monofilament Mesh 3115100 CDM 278 RC facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE FETAL SCALP PHILIPS 3137631 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE FETAL SCALP PHILIPS 3137631 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 31500 Emergency Tracheal Intubation 31500 CDM 963 RC 31500 HCPCS facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price 31500 Emergency Tracheal Intubation 31500 CDM 963 RC 31500 HCPCS facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price 31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE TechFee 315001 CDM 450 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price 31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE TechFee 315001 CDM 450 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price 31500 EMERGENCY INTUBATION ENDO TRACHEAL CHARGE 315002 CDM 761 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price 31500 EMERGENCY INTUBATION ENDO TRACHEAL CHARGE 315002 CDM 761 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price "31500 INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE ProFee" 315003 CDM 982 RC 31500 HCPCS facility both 788 788 Gross Charge Type: NIHD_Hosp_Profee_Price "31500 INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE ProFee" 315003 CDM 982 RC 31500 HCPCS facility both 788 788 Gross Charge Type: NIHD_Hosp_Profee_Price Endotracheal Intubation 315004 CDM 761 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price Endotracheal Intubation 315004 CDM 761 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price Intubation by Respiratory Therapy 315005 CDM 761 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price Intubation by Respiratory Therapy 315005 CDM 761 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price 31530 Laryngoscopy w Fb Removal Tech Fee 31530 CDM 450 RC facility both 4051 4051 Gross Charge Type: NIHD_Hosp_Profee_Price 31530 Laryngoscopy w Fb Removal Tech Fee 31530 CDM 450 RC facility both 4051 4051 Gross Charge Type: NIHD_Hosp_Profee_Price "31530 LARYNHSCOPY, DIRECT, OPERATIVE W/ FOREIG ProFee" 315301 CDM 31530 HCPCS facility both 593 593 Gross Charge Type: NIHD_Hosp_Profee_Price "31530 LARYNHSCOPY, DIRECT, OPERATIVE W/ FOREIG ProFee" 315301 CDM 31530 HCPCS facility both 593 593 Gross Charge Type: NIHD_Hosp_Profee_Price 31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC ProFee 315752 CDM 982 RC 31575 HCPCS facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price 31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC ProFee 315752 CDM 982 RC 31575 HCPCS facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price 31605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE TechFee 31605 CDM 450 RC facility both 2053 2053 Gross Charge Type: NIHD_Hosp_Profee_Price 31605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE TechFee 31605 CDM 450 RC facility both 2053 2053 Gross Charge Type: NIHD_Hosp_Profee_Price "31605 TRACHEOSTOMY,ER PROCED;CRICOTHYROID MEMBR-PF" 316051 CDM 31605 HCPCS facility both 951 951 Gross Charge Type: NIHD_Hosp_Profee_Price "31605 TRACHEOSTOMY,ER PROCED;CRICOTHYROID MEMBR-PF" 316051 CDM 31605 HCPCS facility both 951 951 Gross Charge Type: NIHD_Hosp_Profee_Price "31622 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAG ProFee" 31622 CDM 982 RC 31622 HCPCS facility both 239 239 Gross Charge Type: NIHD_Hosp_Profee_Price "31622 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAG ProFee" 31622 CDM 982 RC 31622 HCPCS facility both 239 239 Gross Charge Type: NIHD_Hosp_Profee_Price "31624 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ProFee" 31624 CDM 982 RC 31624 HCPCS facility both 246 246 Gross Charge Type: NIHD_Hosp_Profee_Price "31624 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ProFee" 31624 CDM 982 RC 31624 HCPCS facility both 246 246 Gross Charge Type: NIHD_Hosp_Profee_Price RT Airway Suction CHARGE 317202 CDM 410 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price RT Airway Suction CHARGE 317202 CDM 410 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price Suction RT 317203 CDM 410 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price Suction RT 317203 CDM 410 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC 317751 CDM 450 RC facility both 585 585 Gross Charge Type: NIHD_Hosp_Profee_Price 31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC 317751 CDM 450 RC facility both 585 585 Gross Charge Type: NIHD_Hosp_Profee_Price Antibody Screen Gel 2 32001023 CDM 390 RC facility both 113 113 Gross Charge Type: NIHD_Hosp_Profee_Price Antibody Screen Gel 2 32001023 CDM 390 RC facility both 113 113 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pleura - Report 324001 CDM 972 RC 32400 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pleura - Report 324001 CDM 972 RC 32400 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pleura 324002 CDM 761 RC facility both TC 2044 2044 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pleura 324002 CDM 761 RC facility both TC 2044 2044 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Pleura 324003 CDM 761 RC facility both TC 2044 2044 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Pleura 324003 CDM 761 RC facility both TC 2044 2044 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Lung/Mediastinum 324081 CDM 402 RC facility both TC 2064 2064 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Lung/Mediastinum 324081 CDM 402 RC facility both TC 2064 2064 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Lung/Mediastinum - Report 324083 CDM 975 RC 32408 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Lung/Mediastinum - Report 324083 CDM 975 RC 32408 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Lung/Mediastinum 324084 CDM 361 RC facility both TC 2064 2064 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Lung/Mediastinum 324084 CDM 361 RC facility both TC 2064 2064 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Lung/Mediastinum 324085 CDM 361 RC facility both TC 2064 2064 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Lung/Mediastinum 324085 CDM 361 RC facility both TC 2064 2064 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Lung/Mediastinum - Report 324086 CDM 975 RC 32408 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Lung/Mediastinum - Report 324086 CDM 975 RC 32408 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price "32551 Tube thoracostomy, includes connection to drainage system, when performed, open" 325511 CDM 521 RC 32551 HCPCS facility both 351 351 Gross Charge Type: NIHD_Clinic_Price Chest Tube Insertion.. 325512 CDM 761 RC facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price Chest Tube Insertion.. 325512 CDM 761 RC facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price 32551 TUBE THORACOSTOMY INCLUDES WATER SEAL TechFee 325513 CDM 450 RC facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price 32551 TUBE THORACOSTOMY INCLUDES WATER SEAL TechFee 325513 CDM 450 RC facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "32551 TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG, WATER SEAL), WHEN PERFO ProFee" 325514 CDM 982 RC 32551 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "32551 TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG, WATER SEAL), WHEN PERFO ProFee" 325514 CDM 982 RC 32551 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 32551 Insertion of Chest Tube Bilat Charges 325515 CDM 761 RC facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price 32551 Insertion of Chest Tube Bilat Charges 325515 CDM 761 RC facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price 32554 THORACENTESIS WO GUIDANCE CHARGE 32554 CDM 761 RC facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price 32554 THORACENTESIS WO GUIDANCE CHARGE 32554 CDM 761 RC facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance" 325541 CDM 521 RC 32554 HCPCS facility both 188 188 Gross Charge Type: NIHD_Clinic_Price 32554 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING TechFee 325542 CDM 450 RC facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price 32554 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING TechFee 325542 CDM 450 RC facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "32554 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GU ProFee" 325543 CDM 982 RC 32554 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "32554 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GU ProFee" 325543 CDM 982 RC 32554 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 32555 THORACENTESIS NURSING CHARGE 325551 CDM 761 RC facility both 2418 2418 Gross Charge Type: NIHD_Hosp_Profee_Price 32555 THORACENTESIS NURSING CHARGE 325551 CDM 761 RC facility both 2418 2418 Gross Charge Type: NIHD_Hosp_Profee_Price "32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDA ProFee" 325552 CDM 982 RC 32555 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDA ProFee" 325552 CDM 982 RC 32555 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price US Thoracentesis - Report 325554 CDM 982 RC 32555 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price US Thoracentesis - Report 325554 CDM 982 RC 32555 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price US Thoracentesis 325555 CDM 320 RC facility both TC 2111 2111 Gross Charge Type: NIHD_Hosp_Profee_Price US Thoracentesis 325555 CDM 320 RC facility both TC 2111 2111 Gross Charge Type: NIHD_Hosp_Profee_Price 32555 Thoracentesis w/ Imaging 325556 CDM 450 RC facility both 2208 2208 Gross Charge Type: NIHD_Hosp_Profee_Price 32555 Thoracentesis w/ Imaging 325556 CDM 450 RC facility both 2208 2208 Gross Charge Type: NIHD_Hosp_Profee_Price 32556 PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING TechFee 32556 CDM 450 RC facility both 2072 2072 Gross Charge Type: NIHD_Hosp_Profee_Price 32556 PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING TechFee 32556 CDM 450 RC facility both 2072 2072 Gross Charge Type: NIHD_Hosp_Profee_Price "32556 ED Pro Fee Pleural drainage, percut, w insert of indwelling cath; w/o image guide" 325561 CDM 32556 HCPCS facility both 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price "32556 ED Pro Fee Pleural drainage, percut, w insert of indwelling cath; w/o image guide" 325561 CDM 32556 HCPCS facility both 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price CT Thoracostomy w/ Drainage 325571 CDM 350 RC facility both 3348 3348 Gross Charge Type: NIHD_Hosp_Profee_Price CT Thoracostomy w/ Drainage 325571 CDM 350 RC facility both 3348 3348 Gross Charge Type: NIHD_Hosp_Profee_Price CT Thoracostomy w/ Drainage - Report 325572 CDM 982 RC 32557 HCPCS facility both 26 394 394 Gross Charge Type: NIHD_Hosp_Profee_Price CT Thoracostomy w/ Drainage - Report 325572 CDM 982 RC 32557 HCPCS facility both 26 394 394 Gross Charge Type: NIHD_Hosp_Profee_Price 32560 INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS CHARGE 32560 CDM 361 RC facility both 2278 2278 Gross Charge Type: NIHD_Hosp_Profee_Price 32560 INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS CHARGE 32560 CDM 361 RC facility both 2278 2278 Gross Charge Type: NIHD_Hosp_Profee_Price LACERATION TRAY FLOOR GRADE 3262114 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price LACERATION TRAY FLOOR GRADE 3262114 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price POWER PICC CATHETER KIT 3275108 CDM 272 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price POWER PICC CATHETER KIT 3275108 CDM 272 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price 33016 PERICARDIOCENT INT W/ IMG TechFee 330161 CDM 450 RC facility both 2739 2739 Gross Charge Type: NIHD_Hosp_Profee_Price 33016 PERICARDIOCENT INT W/ IMG TechFee 330161 CDM 450 RC facility both 2739 2739 Gross Charge Type: NIHD_Hosp_Profee_Price 33016 PERICARDIOCENT INT W/ IMG 330162 CDM 982 RC 33016 HCPCS facility both 407 407 Gross Charge Type: NIHD_Hosp_Profee_Price 33016 PERICARDIOCENT INT W/ IMG 330162 CDM 982 RC 33016 HCPCS facility both 407 407 Gross Charge Type: NIHD_Hosp_Profee_Price "33202 INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY, MEDIAN STERNOTOM ProFee" 33202 CDM 982 RC 33202 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "33202 INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY, MEDIAN STERNOTOM ProFee" 33202 CDM 982 RC 33202 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "33203 INSERTION OF EPICARDIAL ELECTRODE(S); ENDOSCOPIC APPROACH (EG, THORACOSCOPY, PERICARDI ProFee" 33203 CDM 982 RC 33203 HCPCS facility both 1430 1430 Gross Charge Type: NIHD_Hosp_Profee_Price "33203 INSERTION OF EPICARDIAL ELECTRODE(S); ENDOSCOPIC APPROACH (EG, THORACOSCOPY, PERICARDI ProFee" 33203 CDM 982 RC 33203 HCPCS facility both 1430 1430 Gross Charge Type: NIHD_Hosp_Profee_Price 33206 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ProFee 33206 CDM 982 RC 33206 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price 33206 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ProFee 33206 CDM 982 RC 33206 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price 33207 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ProFee 33207 CDM 982 RC 33207 HCPCS facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price 33207 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ProFee 33207 CDM 982 RC 33207 HCPCS facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price 33208 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ProFee 33208 CDM 982 RC 33208 HCPCS facility both 931 931 Gross Charge Type: NIHD_Hosp_Profee_Price 33208 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ProFee 33208 CDM 982 RC 33208 HCPCS facility both 931 931 Gross Charge Type: NIHD_Hosp_Profee_Price 33210 Temporary Pacemaker Charge 332101 CDM 761 RC facility both 13689 13689 Gross Charge Type: NIHD_Hosp_Profee_Price 33210 Temporary Pacemaker Charge 332101 CDM 761 RC facility both 13689 13689 Gross Charge Type: NIHD_Hosp_Profee_Price 33210 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLE CHAMBER CARDIAC ELECTRODE OR ProFee 332102 CDM 982 RC 33210 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price 33210 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLE CHAMBER CARDIAC ELECTRODE OR ProFee 332102 CDM 982 RC 33210 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price 33211 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES (SEPA ProFee 33211 CDM 982 RC 33211 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 33211 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES (SEPA ProFee 33211 CDM 982 RC 33211 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 33212 INSERTION OF PACEMAKER PULSE GENERATOR ONLY; WITH EXISTING SINGLE LEAD ProFee 33212 CDM 982 RC 33212 HCPCS facility both 575 575 Gross Charge Type: NIHD_Hosp_Profee_Price 33212 INSERTION OF PACEMAKER PULSE GENERATOR ONLY; WITH EXISTING SINGLE LEAD ProFee 33212 CDM 982 RC 33212 HCPCS facility both 575 575 Gross Charge Type: NIHD_Hosp_Profee_Price 33213 INSERTION OF PACEMAKER PULSE GENERATOR ONLY; WITH EXISTING DUAL LEADS ProFee 33213 CDM 982 RC 33213 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 33213 INSERTION OF PACEMAKER PULSE GENERATOR ONLY; WITH EXISTING DUAL LEADS ProFee 33213 CDM 982 RC 33213 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "33214 UPGRADE OF IMPLANTED PACEMAKER SYSTEM, CONVERSION OF SINGLE CHAMBER SYSTEM TO DUAL CHA ProFee" 33214 CDM 982 RC 33214 HCPCS facility both 856 856 Gross Charge Type: NIHD_Hosp_Profee_Price "33214 UPGRADE OF IMPLANTED PACEMAKER SYSTEM, CONVERSION OF SINGLE CHAMBER SYSTEM TO DUAL CHA ProFee" 33214 CDM 982 RC 33214 HCPCS facility both 856 856 Gross Charge Type: NIHD_Hosp_Profee_Price 33215 REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR IMPLANTABLE DEFIBRILLAT ProFee 33215 CDM 982 RC 33215 HCPCS facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price 33215 REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR IMPLANTABLE DEFIBRILLAT ProFee 33215 CDM 982 RC 33215 HCPCS facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price "33216 INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBR ProFee" 33216 CDM 982 RC 33216 HCPCS facility both 668 668 Gross Charge Type: NIHD_Hosp_Profee_Price "33216 INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBR ProFee" 33216 CDM 982 RC 33216 HCPCS facility both 668 668 Gross Charge Type: NIHD_Hosp_Profee_Price "33217 INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLATO ProFee" 33217 CDM 982 RC 33217 HCPCS facility both 656 656 Gross Charge Type: NIHD_Hosp_Profee_Price "33217 INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLATO ProFee" 33217 CDM 982 RC 33217 HCPCS facility both 656 656 Gross Charge Type: NIHD_Hosp_Profee_Price "33218 REPAIR OF SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLAT ProFee" 33218 CDM 982 RC 33218 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price "33218 REPAIR OF SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLAT ProFee" 33218 CDM 982 RC 33218 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price "33225 INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT ProFee" 33225 CDM 982 RC 33225 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price "33225 INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT ProFee" 33225 CDM 982 RC 33225 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price 33233 REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR ONLY ProFee 33233 CDM 982 RC 33233 HCPCS facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price 33233 REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR ONLY ProFee 33233 CDM 982 RC 33233 HCPCS facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price 33240 INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING SINGLE LEAD ProFee 33240 CDM 982 RC 33240 HCPCS facility both 656 656 Gross Charge Type: NIHD_Hosp_Profee_Price 33240 INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING SINGLE LEAD ProFee 33240 CDM 982 RC 33240 HCPCS facility both 656 656 Gross Charge Type: NIHD_Hosp_Profee_Price "33270 INSERTION OR REPLACEMENT OF PERMANENT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR SYSTEM, W ProFee" 33270 CDM 982 RC 33270 HCPCS facility both 1018 1018 Gross Charge Type: NIHD_Hosp_Profee_Price "33270 INSERTION OR REPLACEMENT OF PERMANENT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR SYSTEM, W ProFee" 33270 CDM 982 RC 33270 HCPCS facility both 1018 1018 Gross Charge Type: NIHD_Hosp_Profee_Price 33271 INSERTION OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE ProFee 33271 CDM 982 RC 33271 HCPCS facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price 33271 INSERTION OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE ProFee 33271 CDM 982 RC 33271 HCPCS facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price "33285 Insertion, subcutaneous cardiac rhythm monitor, including programming" 33285 CDM 969 RC 33285 HCPCS facility both 18593 18593 Gross Charge Type: NIHD_Hosp_Tech_Price "33285 Insertion, subcutaneous cardiac rhythm monitor, including programming" 33285 CDM 969 RC 33285 HCPCS facility both 18593 18593 Gross Charge Type: NIHD_Hosp_Tech_Price "33285 Insertion, subcutaneous cardiac rhythm monitor, including programming" 33285 CDM 969 RC 33285 HCPCS facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price "33285 Insertion, subcutaneous cardiac rhythm monitor, including programming" 33285 CDM 969 RC 33285 HCPCS facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price "33285 Insertion, subcutaneous cardiac rhythm monitor, including programming" 33285_360 CDM 360 RC 33285 HCPCS facility both 18593 18593 Gross Charge Type: NIHD_Hosp_Tech_Price "33285 Insertion, subcutaneous cardiac rhythm monitor, including programming" 33285_360 CDM 360 RC 33285 HCPCS facility both 18593 18593 Gross Charge Type: NIHD_Hosp_Tech_Price "33285 Insertion, subcutaneous cardiac rhythm monitor, including programming" 33285_360 CDM 360 RC 33285 HCPCS facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price "33285 Insertion, subcutaneous cardiac rhythm monitor, including programming" 33285_360 CDM 360 RC 33285 HCPCS facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price 33285 INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG ProFee 332851 CDM 33285 HCPCS facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price 33285 INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG ProFee 332851 CDM 33285 HCPCS facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price "33286 Removal, subcutaneous cardiac rhythm monitor" 33286 CDM 969 RC 33286 HCPCS facility both 2823 2823 Gross Charge Type: NIHD_Hosp_Tech_Price "33286 Removal, subcutaneous cardiac rhythm monitor" 33286 CDM 969 RC 33286 HCPCS facility both 2823 2823 Gross Charge Type: NIHD_Hosp_Tech_Price "33286 Removal, subcutaneous cardiac rhythm monitor" 33286 CDM 969 RC 33286 HCPCS facility both 266 266 Gross Charge Type: NIHD_Hosp_Profee_Price "33286 Removal, subcutaneous cardiac rhythm monitor" 33286 CDM 969 RC 33286 HCPCS facility both 266 266 Gross Charge Type: NIHD_Hosp_Profee_Price "33286 Removal, subcutaneous cardiac rhythm monitor" 33286_360 CDM 360 RC 33286 HCPCS facility both 2823 2823 Gross Charge Type: NIHD_Hosp_Tech_Price "33286 Removal, subcutaneous cardiac rhythm monitor" 33286_360 CDM 360 RC 33286 HCPCS facility both 2823 2823 Gross Charge Type: NIHD_Hosp_Tech_Price "33286 Removal, subcutaneous cardiac rhythm monitor" 33286_360 CDM 360 RC 33286 HCPCS facility both 266 266 Gross Charge Type: NIHD_Hosp_Profee_Price "33286 Removal, subcutaneous cardiac rhythm monitor" 33286_360 CDM 360 RC 33286 HCPCS facility both 266 266 Gross Charge Type: NIHD_Hosp_Profee_Price 33286 REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR ProFee 332861 CDM 33286 HCPCS facility both 266 266 Gross Charge Type: NIHD_Hosp_Profee_Price 33286 REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR ProFee 332861 CDM 33286 HCPCS facility both 266 266 Gross Charge Type: NIHD_Hosp_Profee_Price "35221 REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL ProFee" 35221 CDM 982 RC 35221 HCPCS facility both 2620 2620 Gross Charge Type: NIHD_Hosp_Profee_Price "35221 REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL ProFee" 35221 CDM 982 RC 35221 HCPCS facility both 2620 2620 Gross Charge Type: NIHD_Hosp_Profee_Price COFLEX TLC LITE TWO-LAYER COMPRESSION SYSTEM 3547861 CDM 272 RC facility both 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price COFLEX TLC LITE TWO-LAYER COMPRESSION SYSTEM 3547861 CDM 272 RC facility both 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 2-0 ON V-20 18IN LONG 3583214 CDM 272 RC facility both 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 2-0 ON V-20 18IN LONG 3583214 CDM 272 RC facility both 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price "35840 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; ABDOMEN ProFee" 35840 CDM 982 RC 35840 HCPCS facility both 2123 2123 Gross Charge Type: NIHD_Hosp_Profee_Price "35840 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; ABDOMEN ProFee" 35840 CDM 982 RC 35840 HCPCS facility both 2123 2123 Gross Charge Type: NIHD_Hosp_Profee_Price "UNNA BOOT Unna-Z Zinc Oxide and Calamine Compression Bandage, 3"" x 10 yd" 3596099 CDM 761 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "UNNA BOOT Unna-Z Zinc Oxide and Calamine Compression Bandage, 3"" x 10 yd" 3596099 CDM 761 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 36000 INTRODUCTION NEEDLE/INTRACATHETER VEIN TechFee 360001 CDM 450 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price 36000 INTRODUCTION NEEDLE/INTRACATHETER VEIN TechFee 360001 CDM 450 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "36000 INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN ProFee" 360002 CDM 982 RC 36000 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "36000 INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN ProFee" 360002 CDM 982 RC 36000 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price 36140 INTRO NDL ICATH UPR/LXTR ART TechFee 361401 CDM 450 RC facility both 2267 2267 Gross Charge Type: NIHD_Hosp_Profee_Price 36140 INTRO NDL ICATH UPR/LXTR ART TechFee 361401 CDM 450 RC facility both 2267 2267 Gross Charge Type: NIHD_Hosp_Profee_Price 36140 INTRODUCTION OF NEEDLE OR INTRACATHETER; EXTREMITY ARTERY ProFee 361402 CDM 982 RC 36140 HCPCS facility both 154 154 Gross Charge Type: NIHD_Hosp_Profee_Price 36140 INTRODUCTION OF NEEDLE OR INTRACATHETER; EXTREMITY ARTERY ProFee 361402 CDM 982 RC 36140 HCPCS facility both 154 154 Gross Charge Type: NIHD_Hosp_Profee_Price Midline Catheter Insertion 361403 CDM 761 RC facility both 294 294 Gross Charge Type: NIHD_Hosp_Profee_Price Midline Catheter Insertion 361403 CDM 761 RC facility both 294 294 Gross Charge Type: NIHD_Hosp_Profee_Price "36400 Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualif" 364001 CDM 521 RC 36400 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price "36400 Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualif" 364001 CDM 521 RC 36400 HCPCS facility both 38 38 Gross Charge Type: NIHD_Clinic_Price "36410 Venipuncture, age 3+ by a physician, for diagnostic/therapeutic purposes" 364101 CDM 521 RC 36410 HCPCS facility both 34 34 Gross Charge Type: NIHD_RHC_Price "36410 Venipuncture, age 3+ by a physician, for diagnostic/therapeutic purposes" 364101 CDM 521 RC 36410 HCPCS facility both 35 35 Gross Charge Type: NIHD_Clinic_Price 36410 VNPNXR 3 YEARS/> PHYS/QHP SKILL TechFee 364102 CDM 450 RC facility both 294 294 Gross Charge Type: NIHD_Hosp_Profee_Price 36410 VNPNXR 3 YEARS/> PHYS/QHP SKILL TechFee 364102 CDM 450 RC facility both 294 294 Gross Charge Type: NIHD_Hosp_Profee_Price 36410 MIDLINE INSERT >3Y PHYS/QHP SKILL Charge 364103 CDM 761 RC facility both 294 294 Gross Charge Type: NIHD_Hosp_Profee_Price 36410 MIDLINE INSERT >3Y PHYS/QHP SKILL Charge 364103 CDM 761 RC facility both 294 294 Gross Charge Type: NIHD_Hosp_Profee_Price "36410 VENIPUNCTURE, AGE 3 YEARS OR OLDER, NECESSITATING THE SKILL OF A PHYSICIAN OR OTHER QU ProFee" 364104 CDM 982 RC 36410 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price "36410 VENIPUNCTURE, AGE 3 YEARS OR OLDER, NECESSITATING THE SKILL OF A PHYSICIAN OR OTHER QU ProFee" 364104 CDM 982 RC 36410 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Venipuncture 36415 CDM 300 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Venipuncture 36415 CDM 300 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price 36415 Collection of venous blood by venipuncture 364151 CDM 521 RC 36415 HCPCS facility both 38 38 Gross Charge Type: NIHD_RHC_Price 36415 Collection of venous blood by venipuncture 364151 CDM 521 RC 36415 HCPCS facility both 39 39 Gross Charge Type: NIHD_Clinic_Price COLLECTION: Venous Draw 364152 CDM 300 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price COLLECTION: Venous Draw 364152 CDM 300 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price COLLECTION: Venous Draw 364153 CDM 300 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price COLLECTION: Venous Draw 364153 CDM 300 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price 36416 Collection of capillary blood specimen 364161 CDM 521 RC 36416 HCPCS facility both 27 27 Gross Charge Type: NIHD_RHC_Price 36416 Collection of capillary blood specimen 364161 CDM 521 RC 36416 HCPCS facility both 27 27 Gross Charge Type: NIHD_Clinic_Price "36425 Venipuncture, cutdown; age 1 or over" 364251 CDM 521 RC 36425 HCPCS facility both 83 83 Gross Charge Type: NIHD_Clinic_Price "36425 VENIPUNCTURE, CUTDOWN; AGE 1 OR OVER ProFee" 364252 CDM 982 RC 36425 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price "36425 VENIPUNCTURE, CUTDOWN; AGE 1 OR OVER ProFee" 364252 CDM 982 RC 36425 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price 36430 - TRANSFUSION BLD/BLD COMPONENTS 36430 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price 36430 - TRANSFUSION BLD/BLD COMPONENTS 36430 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price 36430 TRANSFUSION BLOOD/BLOOD COMPONENTS TechFee 364301 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price 36430 TRANSFUSION BLOOD/BLOOD COMPONENTS TechFee 364301 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price "36430 TRANSFUSION, BLOOD OR BLOOD COMPONENTS ProFee" 364302 CDM 982 RC 36430 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "36430 TRANSFUSION, BLOOD OR BLOOD COMPONENTS ProFee" 364302 CDM 982 RC 36430 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price Transfuse Cryoprecipitate Product 364303 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price Transfuse Cryoprecipitate Product 364303 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price Transfuse Fresh Frozen Plasma 364304 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price Transfuse Fresh Frozen Plasma 364304 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price Transfuse Platelet Product 364305 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price Transfuse Platelet Product 364305 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price Transfuse Red Blood Cells 364306 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price Transfuse Red Blood Cells 364306 CDM 391 RC facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price Central Line Insertion 36510 CDM 361 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Central Line Insertion 36510 CDM 361 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price PICC PLACEMENT INITIAL TECHNICAL FEE 36539 CDM 361 RC facility both 1699 1699 Gross Charge Type: NIHD_Hosp_Profee_Price PICC PLACEMENT INITIAL TECHNICAL FEE 36539 CDM 361 RC facility both 1699 1699 Gross Charge Type: NIHD_Hosp_Profee_Price 36555 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; YOUNGER THAN 5 Y ProFee 36555 CDM 963 RC 36555 HCPCS facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price 36555 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; YOUNGER THAN 5 Y ProFee 36555 CDM 963 RC 36555 HCPCS facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price 36555 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y 365551 CDM 450 RC facility both 1837 1837 Gross Charge Type: NIHD_Hosp_Profee_Price 36555 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y 365551 CDM 450 RC facility both 1837 1837 Gross Charge Type: NIHD_Hosp_Profee_Price 36556 Insertion of non-tunneled central venous catheter; age 5 years or older 365561 CDM 521 RC 36556 HCPCS facility both 501 501 Gross Charge Type: NIHD_Clinic_Price 36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> TechFee 365562 CDM 450 RC facility both 2035 2035 Gross Charge Type: NIHD_Hosp_Profee_Price 36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> TechFee 365562 CDM 450 RC facility both 2035 2035 Gross Charge Type: NIHD_Hosp_Profee_Price 36556 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR O ProFee 365564 CDM 982 RC 36556 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 36556 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR O ProFee 365564 CDM 982 RC 36556 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 36557 INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR 365571 CDM 450 RC facility both 7348 7348 Gross Charge Type: NIHD_Hosp_Profee_Price 36557 INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR 365571 CDM 450 RC facility both 7348 7348 Gross Charge Type: NIHD_Hosp_Profee_Price "36557 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS ProFee" 365572 CDM 982 RC 36557 HCPCS facility both 547 547 Gross Charge Type: NIHD_Hosp_Profee_Price "36557 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS ProFee" 365572 CDM 982 RC 36557 HCPCS facility both 547 547 Gross Charge Type: NIHD_Hosp_Profee_Price "36558 Insertion of tunneled centrally inserted central venous catheter, w/o sub port/pump; age 5+" 365581 CDM 521 RC 36558 HCPCS facility both 525 525 Gross Charge Type: NIHD_Clinic_Price 36558 INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> TechFee 365582 CDM 450 RC facility both 6272 6272 Gross Charge Type: NIHD_Hosp_Profee_Price 36558 INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> TechFee 365582 CDM 450 RC facility both 6272 6272 Gross Charge Type: NIHD_Hosp_Profee_Price "36558 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS ProFee" 365583 CDM 982 RC 36558 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "36558 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS ProFee" 365583 CDM 982 RC 36558 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "36561 Insertion of tunneled centrally inserted central venous access device, w/sub port; age 5+" 365611 CDM 521 RC 36561 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Clinic_Price "36561 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEO ProFee" 365612 CDM 982 RC 36561 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "36561 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEO ProFee" 365612 CDM 982 RC 36561 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "36566 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, REQUIRING 2 CAT ProFee" 36566 CDM 982 RC 36566 HCPCS facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price "36566 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, REQUIRING 2 CAT ProFee" 36566 CDM 982 RC 36566 HCPCS facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price "36569 Insertion of PICC, without subcutaneous port or pump; age 5 years or older" 365691 CDM 521 RC 36569 HCPCS facility both 188 188 Gross Charge Type: NIHD_Clinic_Price PICC PLACEMENT INITIAL TECH FEE 365691 CDM 361 RC facility both 1645 1645 Gross Charge Type: NIHD_Hosp_Profee_Price PICC PLACEMENT INITIAL TECH FEE 365691 CDM 361 RC facility both 1645 1645 Gross Charge Type: NIHD_Hosp_Profee_Price 36569 INSERTION PICC W/O IMG GDN 5 YR/> TechFee 365692 CDM 450 RC facility both 1723 1723 Gross Charge Type: NIHD_Hosp_Profee_Price 36569 INSERTION PICC W/O IMG GDN 5 YR/> TechFee 365692 CDM 450 RC facility both 1723 1723 Gross Charge Type: NIHD_Hosp_Profee_Price "36569 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOU ProFee" 365694 CDM 982 RC 36569 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "36569 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOU ProFee" 365694 CDM 982 RC 36569 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price US Insertion PICC w/o Port >=5 yrs 365695 CDM 361 RC facility both TC 2273 2273 Gross Charge Type: NIHD_Hosp_Profee_Price US Insertion PICC w/o Port >=5 yrs 365695 CDM 361 RC facility both TC 2273 2273 Gross Charge Type: NIHD_Hosp_Profee_Price US Insertion PICC w/o Port >=5 yrs - Report 365696 CDM 960 RC 36569 HCPCS facility both 26 282 282 Gross Charge Type: NIHD_Hosp_Profee_Price US Insertion PICC w/o Port >=5 yrs - Report 365696 CDM 960 RC 36569 HCPCS facility both 26 282 282 Gross Charge Type: NIHD_Hosp_Profee_Price Central Venous Line Insertion 36570 CDM 760 RC facility both 2035 2035 Gross Charge Type: NIHD_Hosp_Profee_Price Central Venous Line Insertion 36570 CDM 760 RC facility both 2035 2035 Gross Charge Type: NIHD_Hosp_Profee_Price 36571 INS PERIPHERALLY CENT VEN DEV W/PORT 5> CHARGE 36571 CDM 975 RC 36571 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price 36571 INS PERIPHERALLY CENT VEN DEV W/PORT 5> CHARGE 36571 CDM 975 RC 36571 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "36571 Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5" 365711 CDM 521 RC 36571 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Clinic_Price "36571 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS POR ProFee" 365712 CDM 982 RC 36571 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "36571 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS POR ProFee" 365712 CDM 982 RC 36571 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price 36573 INSERTION PICC W/RS&I 5 YR/> CHARGE 36573 CDM 361 RC facility both 3678 3678 Gross Charge Type: NIHD_Hosp_Profee_Price 36573 INSERTION PICC W/RS&I 5 YR/> CHARGE 36573 CDM 361 RC facility both 3678 3678 Gross Charge Type: NIHD_Hosp_Profee_Price PICC Line Insertion w/ US (Older than 5yr) 365731 CDM 361 RC facility both 3678 3678 Gross Charge Type: NIHD_Hosp_Profee_Price PICC Line Insertion w/ US (Older than 5yr) 365731 CDM 361 RC facility both 3678 3678 Gross Charge Type: NIHD_Hosp_Profee_Price 36575 GROSHONG CATH REPAIR Charge 36575 CDM 761 RC facility both 1610 1610 Gross Charge Type: NIHD_Hosp_Profee_Price 36575 GROSHONG CATH REPAIR Charge 36575 CDM 761 RC facility both 1610 1610 Gross Charge Type: NIHD_Hosp_Profee_Price 36581 REPLACE CENTRAL VENOUS CATH. ProFee 36581 CDM 982 RC 36581 HCPCS facility both 540 540 Gross Charge Type: NIHD_Hosp_Profee_Price 36581 REPLACE CENTRAL VENOUS CATH. ProFee 36581 CDM 982 RC 36581 HCPCS facility both 540 540 Gross Charge Type: NIHD_Hosp_Profee_Price PICC LINE REMOVAL CHARGE 36589 CDM 361 RC facility both 2218 2218 Gross Charge Type: NIHD_Hosp_Profee_Price PICC LINE REMOVAL CHARGE 36589 CDM 361 RC facility both 2218 2218 Gross Charge Type: NIHD_Hosp_Profee_Price 36589 PICC LINE REMOVAL CHARGE 365891 CDM 361 RC facility both 2218 2218 Gross Charge Type: NIHD_Hosp_Profee_Price 36589 PICC LINE REMOVAL CHARGE 365891 CDM 361 RC facility both 2218 2218 Gross Charge Type: NIHD_Hosp_Profee_Price "36589 REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP ProFee" 365892 CDM 982 RC 36589 HCPCS facility both 243 243 Gross Charge Type: NIHD_Hosp_Profee_Price "36589 REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP ProFee" 365892 CDM 982 RC 36589 HCPCS facility both 243 243 Gross Charge Type: NIHD_Hosp_Profee_Price "36590 Removal of tunneled central venous access device, w/sub port/pump," 365901 CDM 521 RC 36590 HCPCS facility both 624 624 Gross Charge Type: NIHD_Clinic_Price 36590 REMOVAL TUNNELED CV CATH CHARGE 365902 CDM 361 RC facility both 3659 3659 Gross Charge Type: NIHD_Hosp_Profee_Price 36590 REMOVAL TUNNELED CV CATH CHARGE 365902 CDM 361 RC facility both 3659 3659 Gross Charge Type: NIHD_Hosp_Profee_Price "36590 REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENT ProFee" 365903 CDM 982 RC 36590 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "36590 REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENT ProFee" 365903 CDM 982 RC 36590 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 36591 PORTA-CATH BLOOD DRAW Charge 36591 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 36591 PORTA-CATH BLOOD DRAW Charge 36591 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 36592 COLLECT BLOOD FROM PICC Charge 36592 CDM 761 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price 36592 COLLECT BLOOD FROM PICC Charge 36592 CDM 761 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price 36592 PICC Line Draw CHARGE 365922 CDM 761 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price 36592 PICC Line Draw CHARGE 365922 CDM 761 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price 36597 REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GUIDANCE ProFee 36597 CDM 982 RC 36597 HCPCS facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 36597 REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GUIDANCE ProFee 36597 CDM 982 RC 36597 HCPCS facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price "36600 ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS ProFee" 36600 CDM 963 RC 36600 HCPCS facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price "36600 ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS ProFee" 36600 CDM 963 RC 36600 HCPCS facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price COLLECTION: Arterial Draw 366001 CDM 412 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price COLLECTION: Arterial Draw 366001 CDM 412 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price RT Arterial Puncture CHARGE 366003 CDM 412 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price RT Arterial Puncture CHARGE 366003 CDM 412 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "36620 ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPAR ProFee" 36620 CDM 963 RC 36620 HCPCS facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price "36620 ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPAR ProFee" 36620 CDM 963 RC 36620 HCPCS facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price 36620 INSERTION CATHETER ARTERY TechFee 366201 CDM 450 RC facility both 944 944 Gross Charge Type: NIHD_Hosp_Profee_Price 36620 INSERTION CATHETER ARTERY TechFee 366201 CDM 450 RC facility both 944 944 Gross Charge Type: NIHD_Hosp_Profee_Price Arterial Line Insertion 366203 CDM 761 RC facility both 944 944 Gross Charge Type: NIHD_Hosp_Profee_Price Arterial Line Insertion 366203 CDM 761 RC facility both 944 944 Gross Charge Type: NIHD_Hosp_Profee_Price 36660 CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY ProFee 36660 CDM 982 RC 36660 HCPCS facility both 128 128 Gross Charge Type: NIHD_Hosp_Profee_Price 36660 CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY ProFee 36660 CDM 982 RC 36660 HCPCS facility both 128 128 Gross Charge Type: NIHD_Hosp_Profee_Price 36680 PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION ProFee 36680 CDM 982 RC 36680 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price 36680 PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION ProFee 36680 CDM 982 RC 36680 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price CO-FLEX WOUND CARE 3.4YARD 4INCH COMPRES 3695284 CDM 272 RC facility both 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price CO-FLEX WOUND CARE 3.4YARD 4INCH COMPRES 3695284 CDM 272 RC facility both 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE MEDIUM WRAPAROUND 3701461 CDM 274 RC L1820 HCPCS facility both 105 105 Gross Charge Type: NIHD_RHC_Price KNEE BRACE MEDIUM WRAPAROUND 3701461 CDM 274 RC L1820 HCPCS facility both 105 105 Gross Charge Type: NIHD_Clinic_Price KNEE BRACE MEDIUM WRAPAROUND 3701461 CDM 274 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE MEDIUM WRAPAROUND 3701461 CDM 274 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE LARGE WRAPAROUND 3701471 CDM 274 RC L1820 HCPCS facility both 89 89 Gross Charge Type: NIHD_RHC_Price KNEE BRACE LARGE WRAPAROUND 3701471 CDM 274 RC L1820 HCPCS facility both 89 89 Gross Charge Type: NIHD_Clinic_Price KNEE BRACE LARGE WRAPAROUND 3701471 CDM 274 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE LARGE WRAPAROUND 3701471 CDM 274 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE X-LARGE WRAPAROUND 3701481 CDM 274 RC L1810 HCPCS facility both 107 107 Gross Charge Type: NIHD_RHC_Price KNEE BRACE X-LARGE WRAPAROUND 3701481 CDM 274 RC L1810 HCPCS facility both 107 107 Gross Charge Type: NIHD_Clinic_Price KNEE BRACE X-LARGE WRAPAROUND 3701481 CDM 274 RC facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE X-LARGE WRAPAROUND 3701481 CDM 274 RC facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE 2X LARGE WRAPAROUND 3701501 CDM 274 RC L1820 HCPCS facility both 73 73 Gross Charge Type: NIHD_RHC_Price KNEE BRACE 2X LARGE WRAPAROUND 3701501 CDM 274 RC L1820 HCPCS facility both 73 73 Gross Charge Type: NIHD_Clinic_Price KNEE BRACE 2X LARGE WRAPAROUND 3701501 CDM 274 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE 2X LARGE WRAPAROUND 3701501 CDM 274 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price "37609 LIGATION OR BIOPSY, TEMPORAL ARTERY ProFee" 37609 CDM 982 RC 37609 HCPCS facility both 303 303 Gross Charge Type: NIHD_Hosp_Profee_Price "37609 LIGATION OR BIOPSY, TEMPORAL ARTERY ProFee" 37609 CDM 982 RC 37609 HCPCS facility both 303 303 Gross Charge Type: NIHD_Hosp_Profee_Price "37617 LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); ABDOMEN ProFee" 37617 CDM 982 RC 37617 HCPCS facility both 2286 2286 Gross Charge Type: NIHD_Hosp_Profee_Price "37617 LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); ABDOMEN ProFee" 37617 CDM 982 RC 37617 HCPCS facility both 2286 2286 Gross Charge Type: NIHD_Hosp_Profee_Price 37799 ARTERIAL LINE DRAW FOR ABG CHARGE 37799 CDM 412 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 37799 ARTERIAL LINE DRAW FOR ABG CHARGE 37799 CDM 412 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 37799 STAB PHLEBECTOMY (<10 AVULSIONS) ProFee 377992 CDM 37799 HCPCS facility both 1776 1776 Gross Charge Type: NIHD_Hosp_Profee_Price 37799 STAB PHLEBECTOMY (<10 AVULSIONS) ProFee 377992 CDM 37799 HCPCS facility both 1776 1776 Gross Charge Type: NIHD_Hosp_Profee_Price "38120 LAPAROSCOPY, SURGICAL, SPLENECTOMY ProFee" 38120 CDM 982 RC 38120 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price "38120 LAPAROSCOPY, SURGICAL, SPLENECTOMY ProFee" 38120 CDM 982 RC 38120 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price "38129 UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN ProFee" 38129 CDM 982 RC 38129 HCPCS facility both 2271 2271 Gross Charge Type: NIHD_Hosp_Profee_Price "38129 UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN ProFee" 38129 CDM 982 RC 38129 HCPCS facility both 2271 2271 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Bone Marrow w/ Bone Marrow Asp 382211 CDM 761 RC facility both TC 828 828 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Bone Marrow w/ Bone Marrow Asp 382211 CDM 761 RC facility both TC 828 828 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Bone Marrow w/ Bone Marrow Asp - Report 382212 CDM 982 RC 38221 HCPCS facility both 26 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Bone Marrow w/ Bone Marrow Asp - Report 382212 CDM 982 RC 38221 HCPCS facility both 26 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Bone Marrow 382213 CDM 761 RC facility both TC 828 828 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Bone Marrow 382213 CDM 761 RC facility both TC 828 828 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Bone Marrow - Report 382214 CDM 982 RC 38221 HCPCS facility both 26 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Bone Marrow - Report 382214 CDM 982 RC 38221 HCPCS facility both 26 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price "38500 BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL ProFee" 38500 CDM 982 RC 38500 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "38500 BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL ProFee" 38500 CDM 982 RC 38500 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 38505 MG BIOPSY LYMPH NODE SUPERFIC CHARGE 385051 CDM 761 RC facility both 1740 1740 Gross Charge Type: NIHD_Hosp_Profee_Price 38505 MG BIOPSY LYMPH NODE SUPERFIC CHARGE 385051 CDM 761 RC facility both 1740 1740 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Lymph Node 385052 CDM 761 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Lymph Node 385052 CDM 761 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Lymph Node - Report 385053 CDM 982 RC 38505 HCPCS facility both 565 565 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Lymph Node - Report 385053 CDM 982 RC 38505 HCPCS facility both 565 565 Gross Charge Type: NIHD_Hosp_Profee_Price "38510 BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S) ProFee" 38510 CDM 982 RC 38510 HCPCS facility both 880 880 Gross Charge Type: NIHD_Hosp_Profee_Price "38510 BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S) ProFee" 38510 CDM 982 RC 38510 HCPCS facility both 880 880 Gross Charge Type: NIHD_Hosp_Profee_Price "38525 BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S) ProFee" 38525 CDM 982 RC 38525 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "38525 BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S) ProFee" 38525 CDM 982 RC 38525 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "38571 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY ProFee" 38571 CDM 982 RC 38571 HCPCS facility both 1167 1167 Gross Charge Type: NIHD_Hosp_Profee_Price "38571 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY ProFee" 38571 CDM 982 RC 38571 HCPCS facility both 1167 1167 Gross Charge Type: NIHD_Hosp_Profee_Price 38740 ASST REM ARMPIT LYMPH NODES 38740 CDM 982 RC 38740 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 38740 ASST REM ARMPIT LYMPH NODES 38740 CDM 982 RC 38740 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 38745 AXILLARY LYMPHADENECTOMY; COMPLETE ProFee 38745 CDM 982 RC 38745 HCPCS facility both 1777 1777 Gross Charge Type: NIHD_Hosp_Profee_Price 38745 AXILLARY LYMPHADENECTOMY; COMPLETE ProFee 38745 CDM 982 RC 38745 HCPCS facility both 1777 1777 Gross Charge Type: NIHD_Hosp_Profee_Price 38792 INJECTION PROCEDURE; RADIOACTIVE TRACER FOR IDENTIFICATION OF SENTINEL NODE ProFee 387921 CDM 982 RC 38792 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price 38792 INJECTION PROCEDURE; RADIOACTIVE TRACER FOR IDENTIFICATION OF SENTINEL NODE ProFee 387921 CDM 982 RC 38792 HCPCS facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price "38900 INTRAOPERATIVE IDENTIFICATION (EG, MAPPING) OF SENTINEL LYMPH NODE(S) INCLUDES INJECTI ProFee" 38900 CDM 982 RC 38900 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "38900 INTRAOPERATIVE IDENTIFICATION (EG, MAPPING) OF SENTINEL LYMPH NODE(S) INCLUDES INJECTI ProFee" 38900 CDM 982 RC 38900 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "39501 REPAIR, LACERATION OF DIAPHRAGM, ANY APPROACH ProFee" 39501 CDM 982 RC 39501 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "39501 REPAIR, LACERATION OF DIAPHRAGM, ANY APPROACH ProFee" 39501 CDM 982 RC 39501 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price MED SPEC ASO ANKLE STABILIZER XS BLACK 3984753 CDM 274 RC L1902 HCPCS facility both 64 64 Gross Charge Type: NIHD_RHC_Price MED SPEC ASO ANKLE STABILIZER XS BLACK 3984753 CDM 274 RC L1902 HCPCS facility both 64 64 Gross Charge Type: NIHD_Clinic_Price MED SPEC ASO ANKLE STABILIZER XS BLACK 3984753 CDM 274 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price MED SPEC ASO ANKLE STABILIZER XS BLACK 3984753 CDM 274 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price MED SPEC ASO ANKLE STABILIZER SMALL BLAC 3984754 CDM 274 RC L1902 HCPCS facility both 64 64 Gross Charge Type: NIHD_RHC_Price MED SPEC ASO ANKLE STABILIZER SMALL BLAC 3984754 CDM 274 RC L1902 HCPCS facility both 64 64 Gross Charge Type: NIHD_Clinic_Price MED SPEC ASO ANKLE STABILIZER SMALL BLAC 3984754 CDM 274 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price MED SPEC ASO ANKLE STABILIZER SMALL BLAC 3984754 CDM 274 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price MED SPEC ASO ANKLE STABILIZER MED BLACK 3984755 CDM 274 RC L1902 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price MED SPEC ASO ANKLE STABILIZER MED BLACK 3984755 CDM 274 RC L1902 HCPCS facility both 96 96 Gross Charge Type: NIHD_Clinic_Price MED SPEC ASO ANKLE STABILIZER MED BLACK 3984755 CDM 274 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price MED SPEC ASO ANKLE STABILIZER MED BLACK 3984755 CDM 274 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price MED SPEC ASO ANKLE STABILIZER LG BLACK 3984756 CDM 274 RC L1902 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price MED SPEC ASO ANKLE STABILIZER LG BLACK 3984756 CDM 274 RC L1902 HCPCS facility both 96 96 Gross Charge Type: NIHD_Clinic_Price MED SPEC ASO ANKLE STABILIZER LG BLACK 3984756 CDM 274 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price MED SPEC ASO ANKLE STABILIZER LG BLACK 3984756 CDM 274 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price 7973-08 STERILE H20 IRR 3000 4010010 CDM 250 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 7973-08 STERILE H20 IRR 3000 4010010 CDM 250 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 7981-08 SORBITOL MANNITOL 3000CC 4010035 CDM 258 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 7981-08 SORBITOL MANNITOL 3000CC 4010035 CDM 258 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price EXTENSION TUBING 7 SL 1265428 4015135 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price EXTENSION TUBING 7 SL 1265428 4015135 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price Femoral Artery Cath 18G x 4 ½ in 4016002 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Femoral Artery Cath 18G x 4 ½ in 4016002 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price BLOOD SET (NON-VENT) Y-TYPE 12693-28 4020030 CDM 250 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BLOOD SET (NON-VENT) Y-TYPE 12693-28 4020030 CDM 250 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SEC PIGGY LL W/VENT FLA 12667-28(14230-2 4020047 CDM 250 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SEC PIGGY LL W/VENT FLA 12667-28(14230-2 4020047 CDM 250 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price IV SET LL CLAVE W/FILTE 20669-28 4020060 CDM 250 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price IV SET LL CLAVE W/FILTE 20669-28 4020060 CDM 250 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price BLOOD PUMP Y-TYPE 12718 4020080 CDM 250 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price BLOOD PUMP Y-TYPE 12718 4020080 CDM 250 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price THORACENTESIS SET 4653 4020095 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price THORACENTESIS SET 4653 4020095 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price BLOOD FENWALL Y-TYPE RECIPIENT SET 4C216 4020120 CDM 250 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BLOOD FENWALL Y-TYPE RECIPIENT SET 4C216 4020120 CDM 250 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT FROZEN FIBULA 46-65MM 4050190 CDM 278 RC facility both 1182 1182 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT FROZEN FIBULA 46-65MM 4050190 CDM 278 RC facility both 1182 1182 Gross Charge Type: NIHD_Hosp_Profee_Price ceFAZolin 2 g inj [MEMO] 40510376 CDM J0690 HCPCS 60505-6231-05 NDC facility both 1 EA 36.56 36.56 Gross Charge Type: Pharmacy GRAFT FROZEN FIBULA 66-85MM 4051190 CDM 278 RC facility both 1377 1377 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT FROZEN FIBULA 66-85MM 4051190 CDM 278 RC facility both 1377 1377 Gross Charge Type: NIHD_Hosp_Profee_Price "epoetin alfa epbx 10,000 units/mL preservative-free Sol {MEMO}" 40580086 CDM Q5106 HCPCS 00069-1308-10 NDC facility both 1 ML 529.44 529.44 Gross Charge Type: Pharmacy 40650 REPAIR LIP FT; VERMILION ONLY 40650 CDM 450 RC facility both 1752 1752 Gross Charge Type: NIHD_Hosp_Profee_Price 40650 REPAIR LIP FT; VERMILION ONLY 40650 CDM 450 RC facility both 1752 1752 Gross Charge Type: NIHD_Hosp_Profee_Price 40650 REPAIR LIP ProFee 406501 CDM 40650 HCPCS facility both 981 981 Gross Charge Type: NIHD_Hosp_Profee_Price 40650 REPAIR LIP ProFee 406501 CDM 40650 HCPCS facility both 981 981 Gross Charge Type: NIHD_Hosp_Profee_Price 40654 RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE TechFee 40654 CDM 450 RC facility both 2686 2686 Gross Charge Type: NIHD_Hosp_Profee_Price 40654 RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE TechFee 40654 CDM 450 RC facility both 2686 2686 Gross Charge Type: NIHD_Hosp_Profee_Price "40654 REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT, OR COMPLEX ProFee" 406541 CDM 982 RC 40654 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "40654 REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT, OR COMPLEX ProFee" 406541 CDM 982 RC 40654 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price filgrastim 300 mcg/mL Inj Sol [INYO] 4071 CDM J1442 HCPCS 55513-0530-10 NDC facility both 1 ML 2266.8 2266.8 Gross Charge Type: Pharmacy filgrastim 480 mcg/1.6 mL Inj Sol [INYO] 4073 CDM J1442 HCPCS 55513-0546-10 NDC facility both 1.6 ML 4020 4020 Gross Charge Type: Pharmacy 40800-I&D Cyst Mouth Simple 40800 CDM 450 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price 40800-I&D Cyst Mouth Simple 40800 CDM 450 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price "40800 DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE ProFee" 408002 CDM 982 RC 40800 HCPCS facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price "40800 DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE ProFee" 408002 CDM 982 RC 40800 HCPCS facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price 40800 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL TechFee 408003 CDM 450 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price 40800 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL TechFee 408003 CDM 450 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price 40800 DRAIN ABSC VSTBL MOUTH SMP CHARGE 408004 CDM 761 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price 40800 DRAIN ABSC VSTBL MOUTH SMP CHARGE 408004 CDM 761 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price 40804 RMVL EMBEDDED FB VESTIBULE MOUTH SMPL TechFee 408041 CDM 450 RC facility both 1152 1152 Gross Charge Type: NIHD_Hosp_Profee_Price 40804 RMVL EMBEDDED FB VESTIBULE MOUTH SMPL TechFee 408041 CDM 450 RC facility both 1152 1152 Gross Charge Type: NIHD_Hosp_Profee_Price "40804 REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE ProFee" 408042 CDM 982 RC 40804 HCPCS facility both 213 213 Gross Charge Type: NIHD_Hosp_Profee_Price "40804 REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE ProFee" 408042 CDM 982 RC 40804 HCPCS facility both 213 213 Gross Charge Type: NIHD_Hosp_Profee_Price 40830 Repair Mouth Laceration TechFee 40830 CDM 450 RC facility both 305 305 Gross Charge Type: NIHD_Hosp_Profee_Price 40830 Repair Mouth Laceration TechFee 40830 CDM 450 RC facility both 305 305 Gross Charge Type: NIHD_Hosp_Profee_Price "40830 CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS ProFee" 408301 CDM 982 RC 40830 HCPCS facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price "40830 CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS ProFee" 408301 CDM 982 RC 40830 HCPCS facility both 223 223 Gross Charge Type: NIHD_Hosp_Profee_Price Antibody Identification TC 4100028 CDM 309 RC facility both 236.5 236.5 Gross Charge Type: NIHD_Hosp_Profee_Price Antibody Identification TC 4100028 CDM 309 RC facility both 236.5 236.5 Gross Charge Type: NIHD_Hosp_Profee_Price 41010 Incision of lingual frenum (frenotomy) 41010 CDM 521 RC 41010 HCPCS facility both 381 381 Gross Charge Type: NIHD_RHC_Price 41010 Incision of lingual frenum (frenotomy) 41010 CDM 521 RC 41010 HCPCS facility both 381 381 Gross Charge Type: NIHD_Clinic_Price 41110 Excision of lesion of tongue without closure 41110 CDM 521 RC 41110 HCPCS facility both 366 366 Gross Charge Type: NIHD_RHC_Price 41110 Excision of lesion of tongue without closure 41110 CDM 521 RC 41110 HCPCS facility both 366 366 Gross Charge Type: NIHD_Clinic_Price 41250 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG TechFee 412501 CDM 450 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 41250 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG TechFee 412501 CDM 450 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 41250 REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS OF TONG ProFee 412502 CDM 982 RC 41250 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 41250 REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS OF TONG ProFee 412502 CDM 982 RC 41250 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "41252 REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM OR COMPLEX ProFee" 41252 CDM 982 RC 41252 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price "41252 REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM OR COMPLEX ProFee" 41252 CDM 982 RC 41252 HCPCS facility both 1997 1997 Gross Charge Type: NIHD_Hosp_Profee_Price 41252 REPAIR PROCEDURES ON THE TONGUE AND FLOOR OF MOUTH TechFee 412521 CDM 450 RC facility both 1232 1232 Gross Charge Type: NIHD_Hosp_Profee_Price 41252 REPAIR PROCEDURES ON THE TONGUE AND FLOOR OF MOUTH TechFee 412521 CDM 450 RC facility both 1232 1232 Gross Charge Type: NIHD_Hosp_Profee_Price 41800 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS TechFee 418001 CDM 450 RC facility both 394 394 Gross Charge Type: NIHD_Hosp_Profee_Price 41800 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS TechFee 418001 CDM 450 RC facility both 394 394 Gross Charge Type: NIHD_Hosp_Profee_Price Drainage Gum Lesion Charge 418002 CDM 761 RC facility both 394 394 Gross Charge Type: NIHD_Hosp_Profee_Price Drainage Gum Lesion Charge 418002 CDM 761 RC facility both 394 394 Gross Charge Type: NIHD_Hosp_Profee_Price "41800 DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES ProFee" 418003 CDM 982 RC 41800 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price "41800 DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES ProFee" 418003 CDM 982 RC 41800 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price Vaginal Fluid pH POCT 4186161 CDM 300 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Vaginal Fluid pH POCT 4186161 CDM 300 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price "41899 UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES ProFee" 41899 CDM 41899 HCPCS facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price "41899 UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES ProFee" 41899 CDM 41899 HCPCS facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price 41899 UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES 418991 CDM 450 RC facility both 788 788 Gross Charge Type: NIHD_Hosp_Profee_Price 41899 UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES 418991 CDM 450 RC facility both 788 788 Gross Charge Type: NIHD_Hosp_Profee_Price "C-Reactive Protein, Cardiac LC" 41903 CDM 300 RC facility both 6.92 6.92 Gross Charge Type: NIHD_Hosp_Profee_Price "C-Reactive Protein, Cardiac LC" 41903 CDM 300 RC facility both 6.92 6.92 Gross Charge Type: NIHD_Hosp_Profee_Price "Pregnenolone, Mass Spectrometry (Endocrine Sciences) LC" 41916 CDM 301 RC facility both 26.23 26.23 Gross Charge Type: NIHD_Hosp_Profee_Price "Pregnenolone, Mass Spectrometry (Endocrine Sciences) LC" 41916 CDM 301 RC facility both 26.23 26.23 Gross Charge Type: NIHD_Hosp_Profee_Price Antistreptolysin O Ab LC 41954 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price Antistreptolysin O Ab LC 41954 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price "Viral Culture, General LC" 41966 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price "Viral Culture, General LC" 41966 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcium, Ionized, Serum LC" 41968 CDM 300 RC facility both 3.5 3.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcium, Ionized, Serum LC" 41968 CDM 300 RC facility both 3.5 3.5 Gross Charge Type: NIHD_Hosp_Profee_Price CA 19-9 LC 41969 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price CA 19-9 LC 41969 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price Cancer Antigen (CA) 15-3 LC 41978 CDM 300 RC facility both 11.61 11.61 Gross Charge Type: NIHD_Hosp_Profee_Price Cancer Antigen (CA) 15-3 LC 41978 CDM 300 RC facility both 11.61 11.61 Gross Charge Type: NIHD_Hosp_Profee_Price "Clozapine (Clozaril), Serum LC" 41985 CDM 301 RC facility both 20 20 Gross Charge Type: NIHD_Hosp_Profee_Price "Clozapine (Clozaril), Serum LC" 41985 CDM 301 RC facility both 20 20 Gross Charge Type: NIHD_Hosp_Profee_Price "42000 DRAINAGE OF ABSCESS OF PALATE, UVULA TechFee" 42000 CDM 450 RC facility both 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price "42000 DRAINAGE OF ABSCESS OF PALATE, UVULA TechFee" 42000 CDM 450 RC facility both 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price "42000 DRAINAGE OF ABSCESS OF PALATE, UVULA CHARGE" 420001 CDM 761 RC facility both 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price "42000 DRAINAGE OF ABSCESS OF PALATE, UVULA CHARGE" 420001 CDM 761 RC facility both 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price "42000 DRAINAGE OF ABSCESS OF PALATE, UVULA ProFee" 420002 CDM 982 RC 42000 HCPCS facility both 582 582 Gross Charge Type: NIHD_Hosp_Profee_Price "42000 DRAINAGE OF ABSCESS OF PALATE, UVULA ProFee" 420002 CDM 982 RC 42000 HCPCS facility both 582 582 Gross Charge Type: NIHD_Hosp_Profee_Price "Cryoglobulin, Ql, Serum, Rflx LC" 42102 CDM 300 RC facility both 4.7 4.7 Gross Charge Type: NIHD_Hosp_Profee_Price "Cryoglobulin, Ql, Serum, Rflx LC" 42102 CDM 300 RC facility both 4.7 4.7 Gross Charge Type: NIHD_Hosp_Profee_Price "Cytomegalovirus (CMV) Ab, IgG LC" 42103 CDM 301 RC facility both 4.6 4.6 Gross Charge Type: NIHD_Hosp_Profee_Price "Cytomegalovirus (CMV) Ab, IgG LC" 42103 CDM 301 RC facility both 4.6 4.6 Gross Charge Type: NIHD_Hosp_Profee_Price "Estrogens, Total LC" 42108 CDM 301 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price "Estrogens, Total LC" 42108 CDM 301 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price "Fecal Fat, Qualitative LC" 42109 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Fecal Fat, Qualitative LC" 42109 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price Hepatitis Panel (4) LC 42117 CDM 301 RC facility both 15.74 15.74 Gross Charge Type: NIHD_Hosp_Profee_Price Hepatitis Panel (4) LC 42117 CDM 301 RC facility both 15.74 15.74 Gross Charge Type: NIHD_Hosp_Profee_Price Lipoprotein (a) LC 42124 CDM 301 RC facility both 8.76 8.76 Gross Charge Type: NIHD_Hosp_Profee_Price Lipoprotein (a) LC 42124 CDM 301 RC facility both 8.76 8.76 Gross Charge Type: NIHD_Hosp_Profee_Price Ceruloplasmin LC 42157 CDM 301 RC facility both 4.69 4.69 Gross Charge Type: NIHD_Hosp_Profee_Price Ceruloplasmin LC 42157 CDM 301 RC facility both 4.69 4.69 Gross Charge Type: NIHD_Hosp_Profee_Price "Varicella-Zoster V Ab, IgG LC" 42195 CDM 301 RC facility both 3.46 3.46 Gross Charge Type: NIHD_Hosp_Profee_Price "Varicella-Zoster V Ab, IgG LC" 42195 CDM 301 RC facility both 3.46 3.46 Gross Charge Type: NIHD_Hosp_Profee_Price Transferrin LC 42196 CDM 301 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price Transferrin LC 42196 CDM 301 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcitriol(1,25 di-OH Vit D) LC" 42222 CDM 301 RC facility both 9.77 9.77 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcitriol(1,25 di-OH Vit D) LC" 42222 CDM 301 RC facility both 9.77 9.77 Gross Charge Type: NIHD_Hosp_Profee_Price DHEA-Sulfate LC 42226 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price DHEA-Sulfate LC 42226 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin B6, Plasma LC" 42236 CDM 306 RC facility both 7.25 7.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin B6, Plasma LC" 42236 CDM 306 RC facility both 7.25 7.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Aquacel AG Advantage Dressing, 3.5"" x 6""" 4226040 CDM 272 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price "Aquacel AG Advantage Dressing, 3.5"" x 6""" 4226040 CDM 272 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Intermediate 4232581 CDM 129 RC facility both 5240 5240 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Intermediate 4232581 CDM 129 RC facility both 5240 5240 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 LC 42346 CDM 300 RC facility both 12 12 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 LC 42346 CDM 300 RC facility both 12 12 Gross Charge Type: NIHD_Hosp_Profee_Price CA 27.29 LC 42347 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price CA 27.29 LC 42347 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Salivary Gland 424001 CDM 761 RC facility both TC 1678 1678 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Salivary Gland 424001 CDM 761 RC facility both TC 1678 1678 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Salivary Gland 424003 CDM 761 RC facility both TC 1678 1678 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Salivary Gland 424003 CDM 761 RC facility both TC 1678 1678 Gross Charge Type: NIHD_Hosp_Profee_Price 42700 I&D ABSCESS PERITONSILLAR TechFee 427001 CDM 450 RC facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price 42700 I&D ABSCESS PERITONSILLAR TechFee 427001 CDM 450 RC facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price I&D Tonsil Abscess Charge 427002 CDM 761 RC facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price I&D Tonsil Abscess Charge 427002 CDM 761 RC facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price 42700 INCISION AND DRAINAGE ABSCESS; PERITONSILLAR ProFee 427003 CDM 982 RC 42700 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 42700 INCISION AND DRAINAGE ABSCESS; PERITONSILLAR ProFee 427003 CDM 982 RC 42700 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 15 STANDARD 4275 CDM facility both 5128 5128 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 15 STANDARD 4275 CDM facility both 5128 5128 Gross Charge Type: NIHD_Hosp_Profee_Price 42809 REMOVAL FOREIGN BODY PHARYNX TechFee 428091 CDM 450 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 42809 REMOVAL FOREIGN BODY PHARYNX TechFee 428091 CDM 450 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 42809 REMOVAL OF FOREIGN BODY FROM PHARYNX ProFee 428092 CDM 982 RC 42809 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 42809 REMOVAL OF FOREIGN BODY FROM PHARYNX ProFee 428092 CDM 982 RC 42809 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "42999 Throat, adenoids, or tonsils procedure" 429991 CDM 450 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price "42999 Throat, adenoids, or tonsils procedure" 429991 CDM 450 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price "42999 UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS ProFee" 429992 CDM 982 RC 42999 HCPCS facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price "42999 UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS ProFee" 429992 CDM 982 RC 42999 HCPCS facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price "43200 ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY ProFee" 43200 CDM 982 RC 43200 HCPCS facility both 182 182 Gross Charge Type: NIHD_Hosp_Profee_Price "43200 ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY ProFee" 43200 CDM 982 RC 43200 HCPCS facility both 182 182 Gross Charge Type: NIHD_Hosp_Profee_Price "43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, collection of specimen brsh/floss" 432351 CDM 521 RC 43235 HCPCS facility both 1336 1336 Gross Charge Type: NIHD_RHC_Price "43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, collection of specimen brsh/floss" 432351 CDM 521 RC 43235 HCPCS facility both 1336 1336 Gross Charge Type: NIHD_Clinic_Price "43235 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF S ProFee" 432354 CDM 982 RC 43235 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "43235 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF S ProFee" 432354 CDM 982 RC 43235 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "43236 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S) ProFee" 43236 CDM 982 RC 43236 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "43236 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S) ProFee" 43236 CDM 982 RC 43236 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "43239 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 43239 CDM 982 RC 43239 HCPCS facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price "43239 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 43239 CDM 982 RC 43239 HCPCS facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price "43247 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S) ProFee" 43247 CDM 982 RC 43247 HCPCS facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price "43247 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S) ProFee" 43247 CDM 982 RC 43247 HCPCS facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price "43250 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), O ProFee" 43250 CDM 982 RC 43250 HCPCS facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price "43250 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), O ProFee" 43250 CDM 982 RC 43250 HCPCS facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price "43251 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), O ProFee" 43251 CDM 982 RC 43251 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "43251 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), O ProFee" 43251 CDM 982 RC 43251 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "43255 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD ProFee" 43255 CDM 982 RC 43255 HCPCS facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "43255 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD ProFee" 43255 CDM 982 RC 43255 HCPCS facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "43610 EXCISION, LOCAL; ULCER OR BENIGN TUMOR OF STOMACH ProFee" 43610 CDM 982 RC 43610 HCPCS facility both 1798 1798 Gross Charge Type: NIHD_Hosp_Profee_Price "43610 EXCISION, LOCAL; ULCER OR BENIGN TUMOR OF STOMACH ProFee" 43610 CDM 982 RC 43610 HCPCS facility both 1798 1798 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tube Placement NG Gastric (Stomach) 437521 CDM 320 RC facility both TC 560 560 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tube Placement NG Gastric (Stomach) 437521 CDM 320 RC facility both TC 560 560 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tube Placement NG Gastric (Stomach) - Report 437522 CDM 982 RC 43752 HCPCS facility both 26 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tube Placement NG Gastric (Stomach) - Report 437522 CDM 982 RC 43752 HCPCS facility both 26 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price "43752 NASO- OR ORO-GASTRIC TUBE PLACEMENT, REQUIRING PHYSICIAN'S SKILL AND FLUOROSCOPIC GUID ProFee" 437523 CDM 982 RC 43752 HCPCS facility both 122 122 Gross Charge Type: NIHD_Hosp_Profee_Price "43752 NASO- OR ORO-GASTRIC TUBE PLACEMENT, REQUIRING PHYSICIAN'S SKILL AND FLUOROSCOPIC GUID ProFee" 437523 CDM 982 RC 43752 HCPCS facility both 122 122 Gross Charge Type: NIHD_Hosp_Profee_Price 43752 Insertion of nasal or oral stomach tube using fluoroscopic guidance TechFee 437524 CDM 450 RC facility both 733 733 Gross Charge Type: NIHD_Hosp_Profee_Price 43752 Insertion of nasal or oral stomach tube using fluoroscopic guidance TechFee 437524 CDM 450 RC facility both 733 733 Gross Charge Type: NIHD_Hosp_Profee_Price "43762 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imagi" 43762 CDM 521 RC 43762 HCPCS facility both 375 375 Gross Charge Type: NIHD_RHC_Price "43762 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imagi" 43762 CDM 521 RC 43762 HCPCS facility both 375 375 Gross Charge Type: NIHD_Clinic_Price 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC TechFee 437621 CDM 450 RC facility both 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC TechFee 437621 CDM 450 RC facility both 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC ProFee 437622 CDM 982 RC 43762 HCPCS facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC ProFee 437622 CDM 982 RC 43762 HCPCS facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price "43830 GASTROSTOMY, OPEN; WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARAT ProFee" 43830 CDM 982 RC 43830 HCPCS facility both 1299 1299 Gross Charge Type: NIHD_Hosp_Profee_Price "43830 GASTROSTOMY, OPEN; WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARAT ProFee" 43830 CDM 982 RC 43830 HCPCS facility both 1299 1299 Gross Charge Type: NIHD_Hosp_Profee_Price "43840 GASTRORRHAPHY, SUTURE OF PERFORATED DUODENAL OR GASTRIC ULCER, WOUND, OR INJURY ProFee" 43840 CDM 982 RC 43840 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "43840 GASTRORRHAPHY, SUTURE OF PERFORATED DUODENAL OR GASTRIC ULCER, WOUND, OR INJURY ProFee" 43840 CDM 982 RC 43840 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price 44005 ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE) ProFee 44005 CDM 982 RC 44005 HCPCS facility both 2285 2285 Gross Charge Type: NIHD_Hosp_Profee_Price 44005 ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE) ProFee 44005 CDM 982 RC 44005 HCPCS facility both 2285 2285 Gross Charge Type: NIHD_Hosp_Profee_Price "44025 COLOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL ProFee" 44025 CDM 982 RC 44025 HCPCS facility both 1702 1702 Gross Charge Type: NIHD_Hosp_Profee_Price "44025 COLOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL ProFee" 44025 CDM 982 RC 44025 HCPCS facility both 1702 1702 Gross Charge Type: NIHD_Hosp_Profee_Price "44050 REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY ProFee" 44050 CDM 982 RC 44050 HCPCS facility both 1660 1660 Gross Charge Type: NIHD_Hosp_Profee_Price "44050 REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY ProFee" 44050 CDM 982 RC 44050 HCPCS facility both 1660 1660 Gross Charge Type: NIHD_Hosp_Profee_Price ALPRAZolam 1 mg Tab [INYO] 4409 CDM 65862-0678-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ALPRAZolam 1 mg Tab [INYO] 4409 CDM 00904-5860-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ALPRAZolam 1 mg Tab [INYO] 4409 CDM 51079-0790-20 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "44100 BIOPSY OF INTESTINE BY CAPSULE, TUBE, PERORAL (1 OR MORE SPECIMENS) ProFee" 44100 CDM 982 RC 44100 HCPCS facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price "44100 BIOPSY OF INTESTINE BY CAPSULE, TUBE, PERORAL (1 OR MORE SPECIMENS) ProFee" 44100 CDM 982 RC 44100 HCPCS facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price oseltamivir 360 mg/60mL Susp [INYO] 4411 CDM 47781-0384-26 NDC facility both 60 ML 655.4 655.4 Gross Charge Type: Pharmacy oseltamivir 360 mg/60mL Susp [INYO] 4411 CDM 68180-0678-01 NDC facility both 60 ML 654.96 654.96 Gross Charge Type: Pharmacy oseltamivir 360 mg/60mL Susp [INYO] 4411 CDM 00004-0822-05 NDC facility both 60 ML 729.04 729.04 Gross Charge Type: Pharmacy "44110 EXCISION OF 1 OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING ANASTOMOSIS, E ProFee" 44110 CDM 975 RC 44110 HCPCS facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price "44110 EXCISION OF 1 OR MORE LESIONS OF SMALL OR LARGE INTESTINE NOT REQUIRING ANASTOMOSIS, E ProFee" 44110 CDM 975 RC 44110 HCPCS facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price "44120 ENTERECTOMY, RESECTION OF SMALL INTESTINE; SINGLE RESECTION AND ANASTOMOSIS ProFee" 44120 CDM 982 RC 44120 HCPCS facility both 2458 2458 Gross Charge Type: NIHD_Hosp_Profee_Price "44120 ENTERECTOMY, RESECTION OF SMALL INTESTINE; SINGLE RESECTION AND ANASTOMOSIS ProFee" 44120 CDM 982 RC 44120 HCPCS facility both 2458 2458 Gross Charge Type: NIHD_Hosp_Profee_Price "44121 ENTERECTOMY, RESECTION OF SMALL INTESTINE; EACH ADDITIONAL RESECTION AND ANASTOMOSIS ( ProFee" 44121 CDM 975 RC 44121 HCPCS facility both 416 416 Gross Charge Type: NIHD_Hosp_Profee_Price "44121 ENTERECTOMY, RESECTION OF SMALL INTESTINE; EACH ADDITIONAL RESECTION AND ANASTOMOSIS ( ProFee" 44121 CDM 975 RC 44121 HCPCS facility both 416 416 Gross Charge Type: NIHD_Hosp_Profee_Price 44139 MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLE ProFee 44139 CDM 982 RC 44139 HCPCS facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price 44139 MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLE ProFee 44139 CDM 982 RC 44139 HCPCS facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price tadalafil 20 mg Tab [INYO] 4414 CDM 50268-0739-13 NDC facility both 1 EA 288.26 288.26 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tadalafil 20 mg Tab [INYO] 4414 CDM 00378-6976-93 NDC facility both 1 EA 304.61 304.61 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tadalafil 20 mg Tab [INYO] 4414 CDM 68382-0899-06 NDC facility both 1 EA 304.61 304.61 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "44140 COLECTOMY, PARTIAL; WITH ANASTOMOSIS ProFee" 44140 CDM 982 RC 44140 HCPCS facility both 2746 2746 Gross Charge Type: NIHD_Hosp_Profee_Price "44140 COLECTOMY, PARTIAL; WITH ANASTOMOSIS ProFee" 44140 CDM 982 RC 44140 HCPCS facility both 2746 2746 Gross Charge Type: NIHD_Hosp_Profee_Price "44141 COLECTOMY, PARTIAL; WITH SKIN LEVEL CECOSTOMY OR COLOSTOMY ProFee" 44141 CDM 982 RC 44141 HCPCS facility both 3369 3369 Gross Charge Type: NIHD_Hosp_Profee_Price "44141 COLECTOMY, PARTIAL; WITH SKIN LEVEL CECOSTOMY OR COLOSTOMY ProFee" 44141 CDM 982 RC 44141 HCPCS facility both 3369 3369 Gross Charge Type: NIHD_Hosp_Profee_Price "44143 COLECTOMY, PARTIAL; WITH END COLOSTOMY AND CLOSURE OF DISTAL SEGMENT (HARTMANN TYPE PR ProFee" 44143 CDM 982 RC 44143 HCPCS facility both 3057 3057 Gross Charge Type: NIHD_Hosp_Profee_Price "44143 COLECTOMY, PARTIAL; WITH END COLOSTOMY AND CLOSURE OF DISTAL SEGMENT (HARTMANN TYPE PR ProFee" 44143 CDM 982 RC 44143 HCPCS facility both 3057 3057 Gross Charge Type: NIHD_Hosp_Profee_Price "44144 COLECTOMY, PARTIAL; WITH RESECTION, WITH COLOSTOMY OR ILEOSTOMY AND CREATION OF MUCOFI ProFee" 44144 CDM 975 RC 44144 HCPCS facility both 3055 3055 Gross Charge Type: NIHD_Hosp_Profee_Price "44144 COLECTOMY, PARTIAL; WITH RESECTION, WITH COLOSTOMY OR ILEOSTOMY AND CREATION OF MUCOFI ProFee" 44144 CDM 975 RC 44144 HCPCS facility both 3055 3055 Gross Charge Type: NIHD_Hosp_Profee_Price "44145 COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS) ProFee" 44145 CDM 982 RC 44145 HCPCS facility both 2954 2954 Gross Charge Type: NIHD_Hosp_Profee_Price "44145 COLECTOMY, PARTIAL; WITH COLOPROCTOSTOMY (LOW PELVIC ANASTOMOSIS) ProFee" 44145 CDM 982 RC 44145 HCPCS facility both 2954 2954 Gross Charge Type: NIHD_Hosp_Profee_Price "44150 ASST COLECTOMY TOTAL, ABDOMINAL" 44150 CDM 982 RC 44150 HCPCS facility both 3214 3214 Gross Charge Type: NIHD_Hosp_Profee_Price "44150 ASST COLECTOMY TOTAL, ABDOMINAL" 44150 CDM 982 RC 44150 HCPCS facility both 3214 3214 Gross Charge Type: NIHD_Hosp_Profee_Price "44160 COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOLOSTOMY ProFee" 44160 CDM 44160 HCPCS facility both 1842 1842 Gross Charge Type: NIHD_Hosp_Profee_Price "44160 COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOLOSTOMY ProFee" 44160 CDM 44160 HCPCS facility both 1842 1842 Gross Charge Type: NIHD_Hosp_Profee_Price "44180 LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDUR ProFee" 44180 CDM 982 RC 44180 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "44180 LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDUR ProFee" 44180 CDM 982 RC 44180 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "44188 LAPAROSCOPY, SURGICAL, COLOSTOMY OR SKIN LEVEL CECOSTOMY ProFee" 44188 CDM 982 RC 44188 HCPCS facility both 2202 2202 Gross Charge Type: NIHD_Hosp_Profee_Price "44188 LAPAROSCOPY, SURGICAL, COLOSTOMY OR SKIN LEVEL CECOSTOMY ProFee" 44188 CDM 982 RC 44188 HCPCS facility both 2202 2202 Gross Charge Type: NIHD_Hosp_Profee_Price "HBV RT PCR, Quant (Graph) LC" 44197 CDM 301 RC facility both 72 72 Gross Charge Type: NIHD_Hosp_Profee_Price "HBV RT PCR, Quant (Graph) LC" 44197 CDM 301 RC facility both 72 72 Gross Charge Type: NIHD_Hosp_Profee_Price "44202 Lap sm bowel resection, single" 44202 CDM 44202 HCPCS facility both 4174 4174 Gross Charge Type: NIHD_Hosp_Profee_Price "44202 Lap sm bowel resection, single" 44202 CDM 44202 HCPCS facility both 4174 4174 Gross Charge Type: NIHD_Hosp_Profee_Price "44204 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS ProFee" 44204 CDM 982 RC 44204 HCPCS facility both 2870 2870 Gross Charge Type: NIHD_Hosp_Profee_Price "44204 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS ProFee" 44204 CDM 982 RC 44204 HCPCS facility both 2870 2870 Gross Charge Type: NIHD_Hosp_Profee_Price "44205 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOL ProFee" 44205 CDM 44205 HCPCS facility both 4023 4023 Gross Charge Type: NIHD_Hosp_Profee_Price "44205 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH REMOVAL OF TERMINAL ILEUM WITH ILEOCOL ProFee" 44205 CDM 44205 HCPCS facility both 4023 4023 Gross Charge Type: NIHD_Hosp_Profee_Price "44206 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH END COLOSTOMY AND CLOSURE OF DISTAL SE ProFee" 44206 CDM 981 RC 44206 HCPCS facility both 2528 2528 Gross Charge Type: NIHD_Hosp_Profee_Price "44206 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH END COLOSTOMY AND CLOSURE OF DISTAL SE ProFee" 44206 CDM 981 RC 44206 HCPCS facility both 2528 2528 Gross Charge Type: NIHD_Hosp_Profee_Price "44207 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW ProFee" 44207 CDM 982 RC 44207 HCPCS facility both 3669 3669 Gross Charge Type: NIHD_Hosp_Profee_Price "44207 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW ProFee" 44207 CDM 982 RC 44207 HCPCS facility both 3669 3669 Gross Charge Type: NIHD_Hosp_Profee_Price "44208 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW ProFee" 44208 CDM 982 RC 44208 HCPCS facility both 3559 3559 Gross Charge Type: NIHD_Hosp_Profee_Price "44208 LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, WITH ANASTOMOSIS, WITH COLOPROCTOSTOMY (LOW ProFee" 44208 CDM 982 RC 44208 HCPCS facility both 3559 3559 Gross Charge Type: NIHD_Hosp_Profee_Price "44213 LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUN ProFee" 44213 CDM 982 RC 44213 HCPCS facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "44213 LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUN ProFee" 44213 CDM 982 RC 44213 HCPCS facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "44227 LAPAROSCOPY, SURGICAL, CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE, WITH RESECTIO ProFee" 44227 CDM 982 RC 44227 HCPCS facility both 2963 2963 Gross Charge Type: NIHD_Hosp_Profee_Price "44227 LAPAROSCOPY, SURGICAL, CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE, WITH RESECTIO ProFee" 44227 CDM 982 RC 44227 HCPCS facility both 2963 2963 Gross Charge Type: NIHD_Hosp_Profee_Price "44238 UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM) ProFee" 44238 CDM 982 RC 44238 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price "44238 UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM) ProFee" 44238 CDM 982 RC 44238 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price "44310 ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE ProFee" 44310 CDM 982 RC 44310 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price "44310 ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE ProFee" 44310 CDM 982 RC 44310 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price "44340 Revision of colostomy, simple" 44340 CDM 982 RC 44340 HCPCS facility both 1947 1947 Gross Charge Type: NIHD_Hosp_Profee_Price "44340 Revision of colostomy, simple" 44340 CDM 982 RC 44340 HCPCS facility both 1947 1947 Gross Charge Type: NIHD_Hosp_Profee_Price "44345 Revision of colostomy, complicated reconstruction" 44345 CDM 44345 HCPCS facility both 1540 1540 Gross Charge Type: NIHD_Hosp_Profee_Price "44345 Revision of colostomy, complicated reconstruction" 44345 CDM 44345 HCPCS facility both 1540 1540 Gross Charge Type: NIHD_Hosp_Profee_Price voriconazole 200 mg IV Inj [INYO] 4435 CDM J3465 HCPCS 00781-3416-94 NDC facility both 1 EA 457.74 457.74 Gross Charge Type: Pharmacy voriconazole 200 mg IV Inj [INYO] 4435 CDM J3465 HCPCS 00049-3190-38 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy voriconazole 200 mg IV Inj [INYO] 4435 CDM J3465 HCPCS 00049-3190-28 NDC facility both 1 EA 537.09 537.09 Gross Charge Type: Pharmacy "44386 ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH (EG, KOCK POUCH, ILEAL RESERVOIR [S OR ProFee" 44386 CDM 982 RC 44386 HCPCS facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price "44386 ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH (EG, KOCK POUCH, ILEAL RESERVOIR [S OR ProFee" 44386 CDM 982 RC 44386 HCPCS facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price "44388 COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING ProFee" 44388 CDM 982 RC 44388 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "44388 COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING ProFee" 44388 CDM 982 RC 44388 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "44389 COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 44389 CDM 982 RC 44389 HCPCS facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price "44389 COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 44389 CDM 982 RC 44389 HCPCS facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price "44392 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY H ProFee" 44392 CDM 982 RC 44392 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "44392 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY H ProFee" 44392 CDM 982 RC 44392 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "44394 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY S ProFee" 44394 CDM 982 RC 44394 HCPCS facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price "44394 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY S ProFee" 44394 CDM 982 RC 44394 HCPCS facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price hydroCHLOROthiazide 25 MG TAB [INYO] 4440 CDM 63739-0128-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydroCHLOROthiazide 25 MG TAB [INYO] 4440 CDM 60687-0593-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydroCHLOROthiazide 25 MG TAB [INYO] 4440 CDM 16729-0183-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "44404 COLONOSCOPY THROUGH STOMA; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE ProFee" 44404 CDM 982 RC 44404 HCPCS facility both 306 306 Gross Charge Type: NIHD_Hosp_Profee_Price "44404 COLONOSCOPY THROUGH STOMA; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE ProFee" 44404 CDM 982 RC 44404 HCPCS facility both 306 306 Gross Charge Type: NIHD_Hosp_Profee_Price levothyroxine 50 mcg (0.05 mg) Tab [INYO] 4441 CDM 00904-6950-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 50 mcg (0.05 mg) Tab [INYO] 4441 CDM 00074-4552-11 NDC facility both 1 EA 9.35 9.35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 50 mcg (0.05 mg) Tab [inyo] 4441 CDM 60687-0464-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB doxazosin 1 mg Tab [INYO] 4442 CDM 68084-0836-01 NDC facility both 1 EA 6.55 6.55 Gross Charge Type: Pharmacy | NDC EA = 1 TAB doxazosin 1 mg Tab [INYO] 4442 CDM 51079-0957-20 NDC facility both 1 EA 22.59 22.59 Gross Charge Type: Pharmacy | NDC EA = 1 TAB trace elements 10 mcg-1 mg-0.5 mg-5 mg/mL IV Sol 1 mL [INYO] 4443 CDM 00517-7201-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy PARoxetine 20 mg Tab [INYO] 4444 CDM 00904-5677-61 NDC facility both 1 EA 17.62 17.62 Gross Charge Type: Pharmacy | NDC EA = 1 TAB PARoxetine 20 mg Tab [INYO] 4444 CDM 55154-6673-04 NDC facility both 1 EA 16.73 16.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB doxepin 10 mg Cap [INYO] 4445 CDM 00904-6970-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP doxepin 10 mg Cap [INYO] 4445 CDM 00904-7052-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP doxepin 10 mg Cap [INYO] 4445 CDM 51079-0436-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP beclomethasone 80 mcg/inh Inh Aer w/Adapt [INYO] 4451 CDM 59310-0204-12 NDC facility both 1 EA 989.06 989.06 Gross Charge Type: Pharmacy | NDC EA = 8.7 INH Dextrose 10% in Water IV Sol 500 mL [INYO] 4456 CDM 00338-0023-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Dextrose 10% in Water IV Sol 500 mL [INYO] 4456 CDM 00409-7930-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Dextrose 10% in Water IV Sol 500 mL [INYO] 4456 CDM 63323-0824-75 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy gemcitabine 200 mg IV Inj [INYO] 4458 CDM J9201 HCPCS 00002-7501-01 NDC facility both 1 EA 968.73 968.73 Gross Charge Type: Pharmacy "44602 SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, I ProFee" 44602 CDM 982 RC 44602 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "44602 SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, I ProFee" 44602 CDM 982 RC 44602 HCPCS facility both 2807 2807 Gross Charge Type: NIHD_Hosp_Profee_Price "44603 SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, I ProFee" 44603 CDM 982 RC 44603 HCPCS facility both 2994 2994 Gross Charge Type: NIHD_Hosp_Profee_Price "44603 SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, I ProFee" 44603 CDM 982 RC 44603 HCPCS facility both 2994 2994 Gross Charge Type: NIHD_Hosp_Profee_Price "44604 SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJ ProFee" 44604 CDM 982 RC 44604 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price "44604 SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJ ProFee" 44604 CDM 982 RC 44604 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price "44605 SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJ ProFee" 44605 CDM 44605 HCPCS facility both 1882 1882 Gross Charge Type: NIHD_Hosp_Profee_Price "44605 SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJ ProFee" 44605 CDM 44605 HCPCS facility both 1882 1882 Gross Charge Type: NIHD_Hosp_Profee_Price risperiDONE 1 mg Tab [INYO] 4461 CDM 50458-0592-10 NDC facility both 1 EA 14.12 14.12 Gross Charge Type: Pharmacy | NDC EA = 1 TAB risperiDONE 1 mg Tab [INYO] 4461 CDM 00904-6359-61 NDC facility both 1 EA 27.38 27.38 Gross Charge Type: Pharmacy | NDC EA = 1 TAB risperiDONE 1 mg Tab [INYO] 4461 CDM 00904-7362-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoprolol SUCCinate 50 mg ER Tab [INYO] 4462 CDM 00904-6323-61 NDC facility both 1 EA 7.44 7.44 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "44620 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; ProFee" 44620 CDM 982 RC 44620 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price "44620 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; ProFee" 44620 CDM 982 RC 44620 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price "44625 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND ANASTOMOSIS OTHER ProFee" 44625 CDM 982 RC 44625 HCPCS facility both 1822 1822 Gross Charge Type: NIHD_Hosp_Profee_Price "44625 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND ANASTOMOSIS OTHER ProFee" 44625 CDM 982 RC 44625 HCPCS facility both 1822 1822 Gross Charge Type: NIHD_Hosp_Profee_Price "44626 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND COLORECTAL ANASTO ProFee" 44626 CDM 44626 HCPCS facility both 4623 4623 Gross Charge Type: NIHD_Hosp_Profee_Price "44626 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; WITH RESECTION AND COLORECTAL ANASTO ProFee" 44626 CDM 44626 HCPCS facility both 4623 4623 Gross Charge Type: NIHD_Hosp_Profee_Price guaiFENesin 200 mg/10 mL Oral Liq [INYO] 4463 CDM 00121-1488-00 NDC facility both 10 ML 6 6 Gross Charge Type: Pharmacy guaiFENesin 200 mg/10 mL Oral Liq [INYO] 4463 CDM 00121-1744-10 NDC facility both 10 ML 6 6 Gross Charge Type: Pharmacy salmeterol 50 mcg Inh Pwdr [INYO] 4465 CDM 00173-0520-00 NDC facility both 28 EA 1131.08 1131.08 Gross Charge Type: Pharmacy amoxicillin-clavulanate 875 mg-125 mg Tab [INYO] 4466 CDM 42571-0162-01 NDC facility both 1 EA 30.31 30.31 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amoxicillin-clavulanate 875 mg-125 mg Tab [inyo] 4466 CDM 00093-2275-34 NDC facility both 1 EA 30.31 30.31 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amoxicillin-clavulanate 875 mg-125 mg Tab [INYO] 4466 CDM 66685-1001-00 NDC facility both 1 EA 30.31 30.31 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 44701 INTRAOPERATIVE COLONIC LAVAGE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDU ProFee 44701 CDM 975 RC 44701 HCPCS facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price 44701 INTRAOPERATIVE COLONIC LAVAGE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDU ProFee 44701 CDM 975 RC 44701 HCPCS facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price remifentanil 1 mg IV Inj [INYO] 4471 CDM 67457-0198-03 NDC facility both 1 ML 440 440 Gross Charge Type: Pharmacy loratadine 10 mg Tab [INYO] 4473 CDM 51079-0246-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB loratadine 10 mg Tab [INYO] 4473 CDM 50268-0489-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB loratadine 10 mg Tab [INYO] 4473 CDM 00904-6852-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB loratadine 10 mg Tab [INYO] 4473 CDM 00904-5793-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB latanoprost Ophth 0.005% Sol [INYO] 4474 CDM 61314-0547-01 NDC facility both 2.5 ML 380 380 Gross Charge Type: Pharmacy losartan 25 mg Tab [INYO] 4475 CDM 68084-0346-01 NDC facility both 1 EA 10.07 10.07 Gross Charge Type: Pharmacy | NDC EA = 1 TAB losartan 25 mg Tab [INYO]] 4475 CDM 50268-0504-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB losartan 25 mg Tab [INYO] 4475 CDM 00904-7047-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB losartan 25 mg Tab [INYO] 4475 CDM 00904-6391-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pentoxifylline 400 mg ER Tab [INYO] 4477 CDM 00904-5448-61 NDC facility both 1 EA 8.99 8.99 Gross Charge Type: Pharmacy | NDC EA = 1 TAB gemfibrozil 600 mg Tab [INYO] 4478 CDM 50268-0350-15 NDC facility both 1 EA 6.98 6.98 Gross Charge Type: Pharmacy | NDC EA = 1 TAB gemfibrozil 600 mg Tab [INYO] 4478 CDM 60687-0224-01 NDC facility both 1 EA 13.89 13.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 44800 EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY) OR OMPHALOMESENTERIC DUCT ProFee 44800 CDM 982 RC 44800 HCPCS facility both 1548 1548 Gross Charge Type: NIHD_Hosp_Profee_Price 44800 EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY) OR OMPHALOMESENTERIC DUCT ProFee 44800 CDM 982 RC 44800 HCPCS facility both 1548 1548 Gross Charge Type: NIHD_Hosp_Profee_Price irinotecan 20 mg/mL IV 5 mL Sol [INYO] 4485 CDM J9206 HCPCS 00703-4434-11 NDC facility both 5 ML 504.21 504.21 Gross Charge Type: Pharmacy irinotecan 20 mg/mL IV 5 mL Sol [INYO] 4485 CDM J9206 HCPCS 00143-9701-01 NDC facility both 5 ML 525 525 Gross Charge Type: Pharmacy Lactated Ringers IV Sol 500 mL [INYO] 4486 CDM J7120 HCPCS 00338-0117-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Lactated Ringers IV Sol 500 mL [INYO] 4486 CDM J7120 HCPCS 00264-7750-10 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Lactated Ringers IV Sol 500 mL [INYO] 4486 CDM J7120 HCPCS 00409-7953-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy benzocaine Top 20% mucous membrane spray [INYO] 4487 CDM 00283-0679-02 NDC facility both 1 EA 244.02 244.02 Gross Charge Type: Pharmacy | NDC EA = 57 SPRAYS warfarin 3 mg Tab [INYO] 4490 CDM 00056-0188-75 NDC facility both 1 EA 16.04 16.04 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bleomycin 30 units Inj [INYO] 4491 CDM J9040 HCPCS 63323-0137-20 NDC facility both 1 EA 640.78 640.78 Gross Charge Type: Pharmacy ciprofloxacin 250 mg Tab [INYO] 4493 CDM 00143-9927-01 NDC facility both 1 EA 27.56 27.56 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ciprofloxacin 250 mg Tab [INYO] 4493 CDM 68084-0069-01 NDC facility both 1 EA 32.75 32.75 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ciprofloxacin 250 mg Tab [INYO] 4493 CDM 60687-0528-01 NDC facility both 1 EA 32.75 32.75 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sodium chloride 23.4% IV Sol 30 mL 4495 CDM J7131 HCPCS 63323-0093-30 NDC facility both 30 ML 330 330 Gross Charge Type: Pharmacy sodium chloride 23.4% IV Sol 30 mL [INYO] 4495 CDM J7131 HCPCS 63323-0187-30 NDC facility both 30 ML 330 330 Gross Charge Type: Pharmacy 44950 APPENDECTOMY; ProFee 44950 CDM 982 RC 44950 HCPCS facility both 1299 1299 Gross Charge Type: NIHD_Hosp_Profee_Price 44950 APPENDECTOMY; ProFee 44950 CDM 982 RC 44950 HCPCS facility both 1299 1299 Gross Charge Type: NIHD_Hosp_Profee_Price 44960 APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS OR GENERALIZED PERITONITIS ProFee 44960 CDM 982 RC 44960 HCPCS facility both 1516 1516 Gross Charge Type: NIHD_Hosp_Profee_Price 44960 APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS OR GENERALIZED PERITONITIS ProFee 44960 CDM 982 RC 44960 HCPCS facility both 1516 1516 Gross Charge Type: NIHD_Hosp_Profee_Price "44970 LAPAROSCOPY, SURGICAL, APPENDECTOMY ProFee" 44970 CDM 982 RC 44970 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price "44970 LAPAROSCOPY, SURGICAL, APPENDECTOMY ProFee" 44970 CDM 982 RC 44970 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price pneumococcal 23-valent vaccine Inj Sol 0.5 mL [INYO] 4498 CDM 00006-4837-03 NDC facility both 0.5 ML 1009.86 1009.86 Gross Charge Type: Pharmacy ACETYLCYSTEINE 20% VIAL INH 30ML [INYO] 4499 CDM J7608 HCPCS 63323-0690-30 NDC facility both 30 ML 125.03 125.03 Gross Charge Type: Pharmacy benzonatate 100 mg Cap [INYO] 4500 CDM 68084-0214-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP benzonatate 100 mg Cap [INYO] 4500 CDM 00904-7153-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP benzonatate 100 mg Cap [INYO] 4500 CDM 00904-6564-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP benzonatate 100 mg Cap [INYO] 4500 CDM 42806-0714-01 NDC facility both 1 EA 15.02 15.02 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "45005 Incision and drainage of submucosal abscess, rectum" 45005 CDM 521 RC 45005 HCPCS facility both 526 526 Gross Charge Type: NIHD_RHC_Price quinapril 10 mg Tab [INYO] 4502 CDM 43547-0411-09 NDC facility both 1 EA 7.34 7.34 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "45020 INCISION AND DRAINAGE OF DEEP SUPRALEVATOR, PELVIRECTAL, OR RETRORECTAL ABSCESS ProFee" 45020 CDM 982 RC 45020 HCPCS facility both 1198 1198 Gross Charge Type: NIHD_Hosp_Profee_Price "45020 INCISION AND DRAINAGE OF DEEP SUPRALEVATOR, PELVIRECTAL, OR RETRORECTAL ABSCESS ProFee" 45020 CDM 982 RC 45020 HCPCS facility both 1198 1198 Gross Charge Type: NIHD_Hosp_Profee_Price acetylcysteine 20% Inh Sol 4 mL [INYO] 4503 CDM J7608 HCPCS 00517-7604-25 NDC facility both 4 ML 89.77 89.77 Gross Charge Type: Pharmacy acetylcysteine 20% Inh Sol 4 mL [INYO] 4503 CDM J7608 HCPCS 63323-0694-04 NDC facility both 4 ML 92.09 92.09 Gross Charge Type: Pharmacy estradiol 1 mg Tab [INYO] 4504 CDM 00555-0886-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB THERABAND YELLOW 4505001 CDM facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price THERABAND YELLOW 4505001 CDM facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price THERABAND BLUE 4505002 CDM facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price THERABAND BLUE 4505002 CDM facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price THERABAND RED 4505003 CDM facility both 172 172 Gross Charge Type: NIHD_Hosp_Profee_Price THERABAND RED 4505003 CDM facility both 172 172 Gross Charge Type: NIHD_Hosp_Profee_Price THERABAND GREEN 4505004 CDM facility both 316 316 Gross Charge Type: NIHD_Hosp_Profee_Price THERABAND GREEN 4505004 CDM facility both 316 316 Gross Charge Type: NIHD_Hosp_Profee_Price clonazePAM 1 mg Tab [INYO] 4506 CDM 60687-0555-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB clonazePAM 1 mg Tab [inyo] 4506 CDM 50268-0174-15 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB clonazePAM 1 mg Tab [INYO] 4506 CDM 00904-6102-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB clonazePAM 1 mg Tab [INYO] 4506 CDM 43547-0407-10 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB donepezil 5 mg Tab [INYO] 4508 CDM 00904-6477-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB donepezil 5 mg Tab [INYO] 4508 CDM 00904-6408-61 NDC facility both 1 EA 46.7 46.7 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 500 mg Tab [INYO] 4510 CDM 50580-0457-11 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 500 mg Tab [INYO] 4510 CDM 50580-0412-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 500 mg Tab [INYO] 4510 CDM 00904-6720-40 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 500 mg Tab [INYO] 4510 CDM 00536-1172-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen 500 mg Tab [INYO] 4510 CDM 00904-6730-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "45100 BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON) ProFee" 45100 CDM 982 RC 45100 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "45100 BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON) ProFee" 45100 CDM 982 RC 45100 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price heparin 25000 units/500mL-NaCl 0.45% IV [INYO] 4511 CDM J1644 HCPCS 00409-3150-20 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy heparin 25000 units/500mL-NaCl 0.45% IV [INYO] 4511 CDM J1644 HCPCS 63323-0518-77 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy heparin 25000 units/500mL-NaCl 0.45% IV [INYO] 4511 CDM J1644 HCPCS 00409-7651-03 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy "45130 EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; PERINEAL APPROACH ProFee" 45130 CDM 982 RC 45130 HCPCS facility both 1967 1967 Gross Charge Type: NIHD_Hosp_Profee_Price "45130 EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; PERINEAL APPROACH ProFee" 45130 CDM 982 RC 45130 HCPCS facility both 1967 1967 Gross Charge Type: NIHD_Hosp_Profee_Price ciprofloxacin 400 mg/200 mL-5% Sol [inyo] 4514 CDM J0744 HCPCS 00409-3300-24 NDC facility both 200 ML 265 265 Gross Charge Type: Pharmacy ciprofloxacin 400 mg/200 mL IV Sol [INYO] 4514 CDM J0744 HCPCS 36000-0009-24 NDC facility both 200 ML 265 265 Gross Charge Type: Pharmacy ciprofloxacin 400 mg/200 mL IV Sol [INYO] 4514 CDM J0744 HCPCS 00409-4777-02 NDC facility both 200 ML 265 265 Gross Charge Type: Pharmacy "45171 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT INCLUDING MUSCULARIS PROPRIA (IE, PA ProFee" 45171 CDM 982 RC 45171 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "45171 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT INCLUDING MUSCULARIS PROPRIA (IE, PA ProFee" 45171 CDM 982 RC 45171 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "45172 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; INCLUDING MUSCULARIS PROPRIA (IE, FULL T ProFee" 45172 CDM 982 RC 45172 HCPCS facility both 1723 1723 Gross Charge Type: NIHD_Hosp_Profee_Price "45172 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; INCLUDING MUSCULARIS PROPRIA (IE, FULL T ProFee" 45172 CDM 982 RC 45172 HCPCS facility both 1723 1723 Gross Charge Type: NIHD_Hosp_Profee_Price "45172 Excision of rectal tumor, transanal approach; including muscularis propria (ie, full thickness" 451721 CDM 521 RC 45172 HCPCS facility both 1254 1254 Gross Charge Type: NIHD_RHC_Price "45172 Excision of rectal tumor, transanal approach; including muscularis propria (ie, full thickness" 451721 CDM 521 RC 45172 HCPCS facility both 1254 1254 Gross Charge Type: NIHD_Clinic_Price dextrose 25% IV Sol 10 mL [INYO] 4518 CDM 00409-1775-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy potassium chloride 10 mEq/100 mL IV Sol [INYO] 4519 CDM J3480 HCPCS 00990-7074-26 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy potassium chloride 10 mEq/100 mL IV Sol [INYO] 4519 CDM J3480 HCPCS 00338-0709-48 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy potassium chloride 10 mEq/100 mL IV Sol [INYO] 4519 CDM J3480 HCPCS 14789-0109-10 NDC facility both 100 ML 384 384 Gross Charge Type: Pharmacy potassium chloride 10 mEq/100 mL IV Sol [INYO] 4519 CDM J3480 HCPCS 00409-7074-26 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy "45190 DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESICCATION, ELECTROSURGERY, LASER ABLATION, L ProFee" 45190 CDM 982 RC 45190 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "45190 DESTRUCTION OF RECTAL TUMOR (EG, ELECTRODESICCATION, ELECTROSURGERY, LASER ABLATION, L ProFee" 45190 CDM 982 RC 45190 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price prednisoLONE 15 mg/5 mL Oral Syrup [INYO] 4523 CDM J7510 HCPCS 50383-0042-24 NDC facility both 5 ML 14.45 14.45 Gross Charge Type: Pharmacy levothyroxine 125 mcg (0.125 mg) Tab [INYO] 4524 CDM 00904-6955-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 125 mcg (0.125 mg) Tab [INYO] 4524 CDM 51079-0443-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB glyBURIDE 2.5 mg Tab [INYO] 4525 CDM 23155-0057-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB glyBURIDE 2.5 mg Tab [INYO] 4525 CDM 51079-0872-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB fentaNYL 100 mcg Inj 2 mL Sol [INYO] 4526 CDM J3010 HCPCS 00409-9094-22 NDC facility both 2 ML 170 170 Gross Charge Type: Pharmacy fentaNYL 100 mcg Inj 2 mL Sol [INYO] 4526 CDM J3010 HCPCS 00641-6024-10 NDC facility both 2 ML 170 170 Gross Charge Type: Pharmacy fentaNYL 100 mcg Inj 2 mL Sol [INYO] 4526 CDM J3010 HCPCS 00641-6027-25 NDC facility both 2 ML 170 170 Gross Charge Type: Pharmacy FLUoxetine 10 mg Cap [INYO] 4530 CDM 00904-5784-61 NDC facility both 1 EA 14.51 14.51 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "45300 PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY B ProFee" 45300 CDM 982 RC 45300 HCPCS facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price "45300 PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY B ProFee" 45300 CDM 982 RC 45300 HCPCS facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price "45300 Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection by brushing or washing" 453001 CDM 521 RC 45300 HCPCS facility both 206 206 Gross Charge Type: NIHD_Clinic_Price "45307 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY ProFee" 45307 CDM 982 RC 45307 HCPCS facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price "45307 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY ProFee" 45307 CDM 982 RC 45307 HCPCS facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price "45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING O ProFee" 45330 CDM 982 RC 45330 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING O ProFee" 45330 CDM 982 RC 45330 HCPCS facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "45331 SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 45331 CDM 982 RC 45331 HCPCS facility both 575 575 Gross Charge Type: NIHD_Hosp_Profee_Price "45331 SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 45331 CDM 982 RC 45331 HCPCS facility both 575 575 Gross Charge Type: NIHD_Hosp_Profee_Price "45332 SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S) ProFee" 45332 CDM 982 RC 45332 HCPCS facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price "45332 SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S) ProFee" 45332 CDM 982 RC 45332 HCPCS facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price "45333 SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT ProFee" 45333 CDM 982 RC 45333 HCPCS facility both 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price "45333 SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT ProFee" 45333 CDM 982 RC 45333 HCPCS facility both 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price "45334 SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD ProFee" 45334 CDM 982 RC 45334 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "45334 SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD ProFee" 45334 CDM 982 RC 45334 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "45335 SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE ProFee" 45335 CDM 982 RC 45335 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "45335 SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE ProFee" 45335 CDM 982 RC 45335 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price "45337 SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, ProFee" 45337 CDM 982 RC 45337 HCPCS facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price "45337 SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, ProFee" 45337 CDM 982 RC 45337 HCPCS facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price "45346 SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCL ProFee" 45346 CDM 982 RC 45346 HCPCS facility both 285 285 Gross Charge Type: NIHD_Hosp_Profee_Price "45346 SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCL ProFee" 45346 CDM 982 RC 45346 HCPCS facility both 285 285 Gross Charge Type: NIHD_Hosp_Profee_Price "45378 COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR ProFee" 45378 CDM 982 RC 45378 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "45378 COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR ProFee" 45378 CDM 982 RC 45378 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "45379 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S) ProFee" 45379 CDM 982 RC 45379 HCPCS facility both 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price "45379 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S) ProFee" 45379 CDM 982 RC 45379 HCPCS facility both 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price "45380 COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 45380 CDM 982 RC 45380 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "45380 COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 45380 CDM 982 RC 45380 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "45381 COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE ProFee" 45381 CDM 982 RC 45381 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "45381 COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE ProFee" 45381 CDM 982 RC 45381 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "45382 COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD ProFee" 45382 CDM 982 RC 45382 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "45382 COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD ProFee" 45382 CDM 982 RC 45382 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "45384 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT B ProFee" 45384 CDM 982 RC 45384 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price "45384 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT B ProFee" 45384 CDM 982 RC 45384 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price "45385 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE ProFee" 45385 CDM 982 RC 45385 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "45385 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE ProFee" 45385 CDM 982 RC 45385 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "45389 COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC STENT PLACEMENT (INCLUDES PRE- AND POST-DILATIO ProFee" 45389 CDM 982 RC 45389 HCPCS facility both 536 536 Gross Charge Type: NIHD_Hosp_Profee_Price "45389 COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC STENT PLACEMENT (INCLUDES PRE- AND POST-DILATIO ProFee" 45389 CDM 982 RC 45389 HCPCS facility both 536 536 Gross Charge Type: NIHD_Hosp_Profee_Price "45393 COLONOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, M ProFee" 45393 CDM 45393 HCPCS facility both 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price "45393 COLONOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, M ProFee" 45393 CDM 45393 HCPCS facility both 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price "45398 COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS) ProFee" 45398 CDM 982 RC 45398 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "45398 COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS) ProFee" 45398 CDM 982 RC 45398 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price temazepam 15 mg Cap [INYO] 4540 CDM 51079-0418-20 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "45400 LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE) ProFee" 45400 CDM 982 RC 45400 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price "45400 LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE) ProFee" 45400 CDM 982 RC 45400 HCPCS facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price montelukast 10 mg Tab [INYO] 4550 CDM 00904-6808-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB montelukast 10 mg Tab [INYO] 4550 CDM 00904-6808-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB montelukast 10 mg Tab [INYO] 4550 CDM 00904-6529-61 NDC facility both 1 EA 33.47 33.47 Gross Charge Type: Pharmacy | NDC EA = 1 TAB KIT PNEUMOTHORAX ARROW 4550150 CDM 272 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price KIT PNEUMOTHORAX ARROW 4550150 CDM 272 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price atorvastatin 20 mg Tab [INYO] 4552 CDM 00904-6291-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB atorvastatin 20 mg Tab [INYO] 4552 CDM 00904-6291-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB clopidogrel 75 mg Tab [INYO] 4554 CDM 00904-6294-61 NDC facility both 1 EA 26.17 26.17 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 45560 REPAIR OF RECTOCELE (SEPARATE PROCEDURE) ProFee 45560 CDM 982 RC 45560 HCPCS facility both 1461 1461 Gross Charge Type: NIHD_Hosp_Profee_Price 45560 REPAIR OF RECTOCELE (SEPARATE PROCEDURE) ProFee 45560 CDM 982 RC 45560 HCPCS facility both 1461 1461 Gross Charge Type: NIHD_Hosp_Profee_Price codeine-guaiFENesin 10 mg-100 mg/5 mL Oral Syrup 5 mL [INYO] 4560 CDM 00121-1775-00 NDC facility both 5 ML 6 6 Gross Charge Type: Pharmacy codeine-guaiFENesin 10 mg-100 mg/5 mL Oral Syrup 5 mL [INYO] 4560 CDM 00121-1775-05 NDC facility both 5 ML 6 6 Gross Charge Type: Pharmacy tamsulosin 0.4 mg Cap [INYO] 4562 CDM 00904-7383-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP tamsulosin 0.4 mg Cap [INYO] 4562 CDM 50268-0740-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP tamsulosin 0.4 mg Cap [inyo] 4562 CDM 68084-0299-01 NDC facility both 1 EA 25.28 25.28 Gross Charge Type: Pharmacy | NDC EA = 1 CAP tamsulosin 0.4 mg Oral Cap [INYO] 4562 CDM 00904-6401-61 NDC facility both 1 EA 25.25 25.25 Gross Charge Type: Pharmacy | NDC EA = 1 CAP LORazepam 2 mg/mL Inj Sol [INYO] 4565 CDM J2060 HCPCS 00641-6001-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy LORazepam 2 mg/mL Inj Sol [INYO] 4565 CDM J2060 HCPCS 00641-6044-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy sodium phosphate 3 mmol/mL Inj Sol [INYO] 4569 CDM 00409-7391-72 NDC facility both 15 ML 330 330 Gross Charge Type: Pharmacy sodium phosphate 3 mmol/mL Inj Sol [INYO] 4569 CDM 63323-0170-15 NDC facility both 15 ML 330 330 Gross Charge Type: Pharmacy pamidronate 9 mg/mL IV Sol [INYO] 4572 CDM J2430 HCPCS 61703-0326-18 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy oxyCODONE 5 mg Tab [INYO] 4586 CDM 00406-0552-62 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE 5 mg Tab [INYO] 4586 CDM 00904-6966-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE 5 mg Tab 4586 CDM 68084-0354-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE 5 mg Tab [INYO] 4586 CDM 10702-0018-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE 5 mg Tab [INYO] 4586 CDM 42858-0001-10 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE 5 mg Tab [INYO] 4586 CDM 42858-0001-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB PESSARY INCONTINENCE RING SIZE 0 4587634 CDM facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price PESSARY INCONTINENCE RING SIZE 0 4587634 CDM facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price lamiVUDine 150 mg Tab [INYO] 4588 CDM 49702-0203-18 NDC facility both 1 EA 49.89 49.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB glimepiride 2 mg Tab [INYO] 4589 CDM 68084-0326-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB glimepiride 2 mg Tab [INYO] 4589 CDM 50268-0359-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB glimepiride 2 mg Tab [INYO] 4589 CDM 51079-0425-20 NDC facility both 1 EA 7.38 7.38 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 45905 DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL ProFee 45905 CDM 982 RC 45905 HCPCS facility both 309 309 Gross Charge Type: NIHD_Hosp_Profee_Price 45905 DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL ProFee 45905 CDM 982 RC 45905 HCPCS facility both 309 309 Gross Charge Type: NIHD_Hosp_Profee_Price 45910 DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL ProFee 45910 CDM 982 RC 45910 HCPCS facility both 289 289 Gross Charge Type: NIHD_Hosp_Profee_Price 45910 DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL ProFee 45910 CDM 982 RC 45910 HCPCS facility both 289 289 Gross Charge Type: NIHD_Hosp_Profee_Price celecoxib 100 mg Cap [INYO] 4593 CDM 00904-6502-61 NDC facility both 1 EA 26.2 26.2 Gross Charge Type: Pharmacy | NDC EA = 1 CAP cefixime 100 mg/5 mL Oral Liq [INYO] 4595 CDM 65862-0751-50 NDC facility both 50 ML 890.84 890.84 Gross Charge Type: Pharmacy cholestyramine 4 g/9 g Pow UD [INYO] 4598 CDM 27241-0134-36 NDC facility both 1 EA 20.22 20.22 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS cholestyramine 4 g/9 g Pow UD [INYO] 4598 CDM 49884-0465-65 NDC facility both 1 EA 20.22 20.22 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS hydrOXYchloroQUINE 200 MG TAB [INYO] 4599 CDM 00904-7046-06 NDC facility both 1 EA 9.09 9.09 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrOXYchloroQUINE 200 MG TAB [INYO] 4599 CDM 00591-3041-01 NDC facility both 1 EA 24.53 24.53 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrOXYchloroQUINE 200 MG TAB [INYO] 4599 CDM 68382-0096-01 NDC facility both 1 EA 26.16 26.16 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "45990 ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOS ProFee" 45990 CDM 982 RC 45990 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "45990 ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOS ProFee" 45990 CDM 982 RC 45990 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price buPROPion 100 mg Tab [INYO] 4600 CDM 00904-6636-61 NDC facility both 1 EA 11.8 11.8 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 46020 PLACEMENT OF SETON ProFee 46020 CDM 982 RC 46020 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 46020 PLACEMENT OF SETON ProFee 46020 CDM 982 RC 46020 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price collagenase Top 250 units/g 30G Oint [INYO] 4603 CDM 50484-0010-30 NDC facility both 1 EA 1253.76 1253.76 Gross Charge Type: Pharmacy | NDC EA = 30 APP collagenase Top 250 units/g 30G Oint [INYO] 4603 CDM 00064-5010-30 NDC facility both 1 EA 983.04 983.04 Gross Charge Type: Pharmacy | NDC EA = 30 APP "46030 REMOVAL OF ANAL SETON, OTHER MARKER ProFee" 46030 CDM 982 RC 46030 HCPCS facility both 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price "46030 REMOVAL OF ANAL SETON, OTHER MARKER ProFee" 46030 CDM 982 RC 46030 HCPCS facility both 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price 46040 INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE) ProFee 46040 CDM 982 RC 46040 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price 46040 INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE) ProFee 46040 CDM 982 RC 46040 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "46045 INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL, ProFee" 46045 CDM 982 RC 46045 HCPCS facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price "46045 INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL, ProFee" 46045 CDM 982 RC 46045 HCPCS facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price 46050 I&D PERIANAL ABSCESS SUPERFICIAL TechFee 460501 CDM 450 RC facility both 987 987 Gross Charge Type: NIHD_Hosp_Profee_Price 46050 I&D PERIANAL ABSCESS SUPERFICIAL TechFee 460501 CDM 450 RC facility both 987 987 Gross Charge Type: NIHD_Hosp_Profee_Price "46050 INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL ProFee" 460502 CDM 982 RC 46050 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "46050 INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL ProFee" 460502 CDM 982 RC 46050 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "46050 Incision and drainage, perianal abscess, superficial" 460503 CDM 521 RC 46050 HCPCS facility both 381 381 Gross Charge Type: NIHD_RHC_Price "46050 Incision and drainage, perianal abscess, superficial" 460503 CDM 521 RC 46050 HCPCS facility both 381 381 Gross Charge Type: NIHD_Clinic_Price 46060 I & D of ischiorectal/intramural abscess with Fistulectomy 46060 CDM 981 RC 46060 HCPCS facility both 1539 1539 Gross Charge Type: NIHD_Hosp_Profee_Price 46060 I & D of ischiorectal/intramural abscess with Fistulectomy 46060 CDM 981 RC 46060 HCPCS facility both 1539 1539 Gross Charge Type: NIHD_Hosp_Profee_Price "46080 SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE) ProFee" 46080 CDM 982 RC 46080 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "46080 SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE) ProFee" 46080 CDM 982 RC 46080 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "46083 INCISION OF THROMBOSED HEMORRHOID, EXTERNAL ProFee" 46083 CDM 982 RC 46083 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "46083 INCISION OF THROMBOSED HEMORRHOID, EXTERNAL ProFee" 46083 CDM 982 RC 46083 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 46083 INCISION THROMBOSED HEMORRHOID EXTERNAL TechFee 460831 CDM 450 RC facility both 590 590 Gross Charge Type: NIHD_Hosp_Profee_Price 46083 INCISION THROMBOSED HEMORRHOID EXTERNAL TechFee 460831 CDM 450 RC facility both 590 590 Gross Charge Type: NIHD_Hosp_Profee_Price citric acid-sodium citrate 1002 mg-1500 mg/15 mL Oral Sol [INYO] 334 mg-500 mg/5 mL Liquid 4612 CDM 57237-0319-52 NDC facility both 15 ML 12.06 12.06 Gross Charge Type: Pharmacy citric acid-sodium citrate 1002 mg-1500 mg/15 mL Oral Sol [INYO] 4612 CDM 00121-0595-15 NDC facility both 15 ML 12.06 12.06 Gross Charge Type: Pharmacy levofloxacin 500 mg Tab [INYO] 4620 CDM 00904-6352-61 NDC facility both 1 EA 84.1 84.1 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "46220 EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS ProFee" 46220 CDM 982 RC 46220 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "46220 EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS ProFee" 46220 CDM 982 RC 46220 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "46220 EXC OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS" 462201 CDM 521 RC 46220 HCPCS facility both 402 402 Gross Charge Type: NIHD_RHC_Price "46220 EXC OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS" 462201 CDM 521 RC 46220 HCPCS facility both 402 402 Gross Charge Type: NIHD_Clinic_Price "46221 Hemorrhoidectomy, internal, by rubber band ligation(s)" 46221 CDM 521 RC 46221 HCPCS facility both 524 524 Gross Charge Type: NIHD_RHC_Price "46221 Hemorrhoidectomy, internal, by rubber band ligation(s)" 46221 CDM 521 RC 46221 HCPCS facility both 524 524 Gross Charge Type: NIHD_Clinic_Price "46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) ProFee" 46221 CDM 982 RC 46221 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) ProFee" 46221 CDM 982 RC 46221 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price nitroglycerin 2% Top Oint [INYO] 4623 CDM 00281-0326-08 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 INCH "46230 EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS ProFee" 46230 CDM 982 RC 46230 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price "46230 EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS ProFee" 46230 CDM 982 RC 46230 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price "46230 Excision of multiple external papillae or tags, anus" 462301 CDM 521 RC 46230 HCPCS facility both 494 494 Gross Charge Type: NIHD_RHC_Price "46230 Excision of multiple external papillae or tags, anus" 462301 CDM 521 RC 46230 HCPCS facility both 494 494 Gross Charge Type: NIHD_Clinic_Price gabapentin 100 mg Cap [INYO] 4624 CDM 63739-0902-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP gabapentin 100 mg Cap [INYO] 4624 CDM 00904-6665-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP gabapentin 100 mg Cap [INYO] 4624 CDM 60687-0580-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP gabapentin 100 mg Cap [INYO] 4624 CDM 00904-5631-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; ProFee" 46255 CDM 982 RC 46255 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price "46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; ProFee" 46255 CDM 982 RC 46255 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price "46260 Hemorrhoidectomy, internal and external, 2 or more columns/groups" 462601 CDM 521 RC 46260 HCPCS facility both 999 999 Gross Charge Type: NIHD_Clinic_Price "46260 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; ProFee" 462602 CDM 982 RC 46260 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "46260 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; ProFee" 462602 CDM 982 RC 46260 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 46270 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS ProFee 46270 CDM 982 RC 46270 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price 46270 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS ProFee 46270 CDM 982 RC 46270 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price 46275 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC ProFee 46275 CDM 982 RC 46275 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 46275 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC ProFee 46275 CDM 982 RC 46275 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price oxyCODONE 20 mg ER Tab [INYO] 4628 CDM 59011-0420-10 NDC facility both 1 EA 47.29 47.29 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE 20 mg ER Tab [INYO] 4628 CDM 59011-0420-20 NDC facility both 1 EA 50.92 50.92 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "46280 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC, SUPRA ProFee" 46280 CDM 982 RC 46280 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "46280 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC, SUPRA ProFee" 46280 CDM 982 RC 46280 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 46285 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE ProFee 46285 CDM 982 RC 46285 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 46285 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE ProFee 46285 CDM 982 RC 46285 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price 46288 CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP ProFee 46288 CDM 982 RC 46288 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price 46288 CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP ProFee 46288 CDM 982 RC 46288 HCPCS facility both 1148 1148 Gross Charge Type: NIHD_Hosp_Profee_Price "46320 Excision of thrombosed hemorrhoid, external" 463201 CDM 521 RC 46320 HCPCS facility both 346 346 Gross Charge Type: NIHD_RHC_Price "46320 Excision of thrombosed hemorrhoid, external" 463201 CDM 521 RC 46320 HCPCS facility both 346 346 Gross Charge Type: NIHD_Clinic_Price 46320 ED REMOVAL OF HEMORRHOID CLOT TechFee 463202 CDM 450 RC facility both 2190 2190 Gross Charge Type: NIHD_Hosp_Profee_Price 46320 ED REMOVAL OF HEMORRHOID CLOT TechFee 463202 CDM 450 RC facility both 2190 2190 Gross Charge Type: NIHD_Hosp_Profee_Price "46320 EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL ProFee" 463203 CDM 982 RC 46320 HCPCS facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price "46320 EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL ProFee" 463203 CDM 982 RC 46320 HCPCS facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price divalproex sodium DR 250 mg Tab [INYO] 4633 CDM 00904-6860-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oseltamivir 75 mg Cap [INYO] 4635 CDM 68180-0677-11 NDC facility both 1 EA 77.29 77.29 Gross Charge Type: Pharmacy | NDC EA = 1 CAP oseltamivir 75 mg Cap [INYO] 4635 CDM 00004-0800-85 NDC facility both 1 EA 91.13 91.13 Gross Charge Type: Pharmacy | NDC EA = 1 CAP fosinopril 20 mg Tab [INYO] 4637 CDM 31722-0201-90 NDC facility both 1 EA 7.14 7.14 Gross Charge Type: Pharmacy | NDC EA = 1 TAB citalopram 20 mg Tab [INYO] 4639 CDM 00904-6085-61 NDC facility both 1 EA 16.16 16.16 Gross Charge Type: Pharmacy | NDC EA = 1 TAB indocyanine green 25 mg Inj [INYO] 4640 CDM 70100-0424-02 NDC facility both 1 EA 1520 1520 Gross Charge Type: Pharmacy indocyanine green 25 mg Inj [INYO] 4640 CDM 17238-0424-06 NDC facility both 1 EA 791.67 791.67 Gross Charge Type: Pharmacy levothyroxine 112 mcg (0.112 mg) Tab [INYO] 4642 CDM 00904-6954-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 112 mcg (0.112 mg) Tab [INYO] 4642 CDM 00074-9296-90 NDC facility both 1 EA 9.35 9.35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sodium chloride 10% Inh Sol 15 mL [INYO] 4643 CDM 00378-6998-89 NDC facility both 15 ML 36 36 Gross Charge Type: Pharmacy sotalol 80 mg Tab [INYO] 4644 CDM 60505-0080-00 NDC facility both 1 EA 15.37 15.37 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sotalol 80 mg Tab [INYO] 4644 CDM 00904-7143-61 NDC facility both 1 EA 8.04 8.04 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sotalol 80 mg Tab [INYO] 4644 CDM 00245-0012-01 NDC facility both 1 EA 15.65 15.65 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "46500 Injection of sclerosing solution, hemorrhoids" 465001 CDM 521 RC 46500 HCPCS facility both 411 411 Gross Charge Type: NIHD_Clinic_Price "46500 INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS ProFee" 465002 CDM 982 RC 46500 HCPCS facility both 333 333 Gross Charge Type: NIHD_Hosp_Profee_Price "46500 INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS ProFee" 465002 CDM 982 RC 46500 HCPCS facility both 333 333 Gross Charge Type: NIHD_Hosp_Profee_Price 46505 CHEMODENERVATION OF INTERNAL ANAL SPHINCTER ProFee 46505 CDM 982 RC 46505 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 46505 CHEMODENERVATION OF INTERNAL ANAL SPHINCTER ProFee 46505 CDM 982 RC 46505 HCPCS facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price azithromycin 1 g Pow [inyo] 4651 CDM Q0144 HCPCS 59762-3051-02 NDC facility both 1 EA 145.63 145.63 Gross Charge Type: Pharmacy diphenhydrAMINE 12.5 mg/5 mL Liq [INYO] 4653 CDM Q0163 HCPCS 57237-0317-51 NDC facility both 5 ML 14.77 14.77 Gross Charge Type: Pharmacy diphenhydrAMINE 12.5 mg/5 mL Oral Liq [INYO] 4653 CDM Q0163 HCPCS 00121-0865-30 NDC facility both 5 ML 15.35 15.35 Gross Charge Type: Pharmacy diphenhydrAMINE 12.5 mg/5 mL Liq [INYO] 4653 CDM Q0163 HCPCS 69339-0151-19 NDC facility both 5 ML 14.77 14.77 Gross Charge Type: Pharmacy pravastatin 20 mg Tab [INYO] 4657 CDM 00904-5892-61 NDC facility both 1 EA 14.97 14.97 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pravastatin 20 mg Tab [INYO] 4657 CDM 68084-0501-01 NDC facility both 1 EA 19.51 19.51 Gross Charge Type: Pharmacy | NDC EA = 1 TAB calcitonin 200 intl units/inh Nasal Spry [INYO] 4659 CDM 49884-0161-11 NDC facility both 1 EA 474.16 474.16 Gross Charge Type: Pharmacy | NDC EA = 3.7 SPRAYS hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [INYO] 4660 CDM 58160-0820-52 NDC facility both 0.5 ML 242.17 242.17 Gross Charge Type: Pharmacy hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [INYO] 4660 CDM 58160-0820-11 NDC facility both 0.5 ML 235 235 Gross Charge Type: Pharmacy "46600 Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when perform" 466001 CDM 521 RC 46600 HCPCS facility both 130 130 Gross Charge Type: NIHD_RHC_Price "46600 Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when perform" 466001 CDM 521 RC 46600 HCPCS facility both 89 89 Gross Charge Type: NIHD_Clinic_Price "46600 ANOSCOPY; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN ProFee" 466002 CDM 982 RC 46600 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "46600 ANOSCOPY; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN ProFee" 466002 CDM 982 RC 46600 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 46600 Diagnostic Anoscopy TechFee 466003 CDM 450 RC facility both 281 281 Gross Charge Type: NIHD_Hosp_Profee_Price 46600 Diagnostic Anoscopy TechFee 466003 CDM 450 RC facility both 281 281 Gross Charge Type: NIHD_Hosp_Profee_Price "46606 Anoscopy; with biopsy, single or multiple" 466061 CDM 521 RC 46606 HCPCS facility both 146 146 Gross Charge Type: NIHD_Clinic_Price "46606 ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 466062 CDM 982 RC 46606 HCPCS facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price "46606 ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE ProFee" 466062 CDM 982 RC 46606 HCPCS facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price "46615 Anoscopy, with lesion ablation not amenable to removal by hot biopsy forceps, bipolar cautery" 46615 CDM 521 RC 46615 HCPCS facility both 138 138 Gross Charge Type: NIHD_RHC_Price "46615 Anoscopy, with lesion ablation not amenable to removal by hot biopsy forceps, bipolar cautery" 46615 CDM 521 RC 46615 HCPCS facility both 138 138 Gross Charge Type: NIHD_Clinic_Price labetalol 20 mg/4 mL IV Sol [INYO] 4663 CDM J1920 HCPCS 00409-2339-34 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy "46707 REPAIR OF ANORECTAL FISTULA WITH PLUG (EG, PORCINE SMALL INTESTINE SUBMUCOSA [SIS]) ProFee" 46707 CDM 982 RC 46707 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "46707 REPAIR OF ANORECTAL FISTULA WITH PLUG (EG, PORCINE SMALL INTESTINE SUBMUCOSA [SIS]) ProFee" 46707 CDM 982 RC 46707 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price gabapentin 300 mg Cap [INYO] 4682 CDM 00904-6666-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP gabapentin 300 mg Cap [INYO] 4682 CDM 60687-0591-01 NDC facility both 1 EA 8.26 8.26 Gross Charge Type: Pharmacy | NDC EA = 1 CAP gabapentin 300 mg Cap [INYO] 4682 CDM 67877-0223-01 NDC facility both 1 EA 8.03 8.03 Gross Charge Type: Pharmacy | NDC EA = 1 CAP gabapentin 300 mg Cap [INYO] 4682 CDM 63739-0236-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP glimepiride 4 mg Tab [INYO] 4686 CDM 51079-0426-20 NDC facility both 1 EA 7.38 7.38 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "46922 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPE ProFee" 46922 CDM 982 RC 46922 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "46922 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPE ProFee" 46922 CDM 982 RC 46922 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "46922 Surgical excision, destruction of lesion (s), anus" 469221 CDM 521 RC 46922 HCPCS facility both 505 505 Gross Charge Type: NIHD_RHC_Price "46922 Surgical excision, destruction of lesion (s), anus" 469221 CDM 521 RC 46922 HCPCS facility both 505 505 Gross Charge Type: NIHD_Clinic_Price 46930 Destruction of internal hemorrhoid(s) by thermal energy 46930 CDM 521 RC 46930 HCPCS facility both 402 402 Gross Charge Type: NIHD_RHC_Price 46930 Destruction of internal hemorrhoid(s) by thermal energy 46930 CDM 521 RC 46930 HCPCS facility both 402 402 Gross Charge Type: NIHD_Clinic_Price "46945 Hemorrhoidectomy, SINGLE internal, by ligation other than rubber band;" 469451 CDM 521 RC 46945 HCPCS facility both 594 594 Gross Charge Type: NIHD_RHC_Price "46945 Hemorrhoidectomy, SINGLE internal, by ligation other than rubber band;" 469451 CDM 521 RC 46945 HCPCS facility both 594 594 Gross Charge Type: NIHD_Clinic_Price "46945 HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; SINGLE HEMORRHOID COLU ProFee" 469452 CDM 982 RC 46945 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "46945 HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; SINGLE HEMORRHOID COLU ProFee" 469452 CDM 982 RC 46945 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "46946 Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/g" 469461 CDM 521 RC 46946 HCPCS facility both 588 588 Gross Charge Type: NIHD_RHC_Price "46946 Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/g" 469461 CDM 521 RC 46946 HCPCS facility both 588 588 Gross Charge Type: NIHD_Clinic_Price "46946 HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; 2 OR MORE HEMORRHOID C ProFee" 469462 CDM 982 RC 46946 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "46946 HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THAN RUBBER BAND; 2 OR MORE HEMORRHOID C ProFee" 469462 CDM 982 RC 46946 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "46947 HEMORRHOIDOPEXY (EG, FOR PROLAPSING INTERNAL HEMORRHOIDS) BY STAPLING ProFee" 46947 CDM 982 RC 46947 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price "46947 HEMORRHOIDOPEXY (EG, FOR PROLAPSING INTERNAL HEMORRHOIDS) BY STAPLING ProFee" 46947 CDM 982 RC 46947 HCPCS facility both 799 799 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Liver - Report 470001 CDM 982 RC 47000 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Liver - Report 470001 CDM 982 RC 47000 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Liver 470002 CDM 761 RC facility both TC 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Liver 470002 CDM 761 RC facility both TC 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Liver - Report 470003 CDM 982 RC 47000 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Liver - Report 470003 CDM 982 RC 47000 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Liver 470004 CDM 761 RC facility both TC 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Liver 470004 CDM 761 RC facility both TC 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price ketorolac Ophth 0.5% Sol [INYO] 4706 CDM 17478-0209-19 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS ketorolac ophthalmic 0.5% Sol [inyo] 4706 CDM 42571-0137-25 NDC facility both 1 EA 424 424 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS ketorolac Ophth 0.5% Sol [INYO] 4706 CDM 47335-0220-90 NDC facility both 1 EA 425.12 425.12 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS ketorolac Ophth 0.5% Sol [INYO] 4706 CDM 17478-0209-10 NDC facility both 1 EA 427.48 427.48 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS ramipril 5 mg Cap [INYO] 4707 CDM 65862-0476-01 NDC facility both 1 EA 11.37 11.37 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ramipril 2.5 mg Cap [INYO] 4708 CDM 65862-0475-01 NDC facility both 1 EA 10.84 10.84 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ramipril 2.5 mg Cap [INYO] 4708 CDM 00054-0107-20 NDC facility both 1 EA 10.84 10.84 Gross Charge Type: Pharmacy | NDC EA = 1 CAP levothyroxine 88 mcg (0.088 mg) Tab [INYO] 4709 CDM 42292-0038-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 88 mcg (0.088 mg) Tab [INYO] 4709 CDM 60687-0486-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 88 mcg (0.088 mg) Tab [INYO] 4709 CDM 00904-6952-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 88 mcg (0.088 mg) Tab [INYO] 4709 CDM 00074-6594-90 NDC facility both 1 EA 9.35 9.35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cetirizine 10 mg Tab [INYO] 4710 CDM 00904-6717-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cetirizine 10 mg Tab [INYO] 4710 CDM 00904-5852-61 NDC facility both 1 EA 14.55 14.55 Gross Charge Type: Pharmacy | NDC EA = 1 TAB finasteride 5 mg Tab [INYO] 4711 CDM S0138 HCPCS 60687-0428-65 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB finasteride 5 mg Tab [INYO] 4711 CDM S0138 HCPCS 00904-6830-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB finasteride 5 mg Tab [INYO] 4711 CDM S0138 HCPCS 16729-0090-15 NDC facility both 1 EA 18.76 18.76 Gross Charge Type: Pharmacy | NDC EA = 1 TAB finasteride 5 mg Tab [INYO] 4711 CDM S0138 HCPCS 60687-0428-01 NDC facility both 1 EA 6.48 6.48 Gross Charge Type: Pharmacy | NDC EA = 1 TAB finasteride 5 mg Tab [INYO] 4711 CDM S0138 HCPCS 50268-0323-15 NDC facility both 1 EA 18.92 18.92 Gross Charge Type: Pharmacy | NDC EA = 1 TAB eptifibatide 0.75 mg/mL IV Sol [INYO] 4715 CDM J1327 HCPCS 00085-1136-01 NDC facility both 100 ML 4020 4020 Gross Charge Type: Pharmacy inFLIXimab 100 mg IV Inj [INYO] 4716 CDM J1745 HCPCS 57894-0160-01 NDC facility both 1 EA 2850 2850 Gross Charge Type: Pharmacy inFLIXimab 100 mg IV Inj [INYO] 4716 CDM J1745 HCPCS 57894-0030-01 NDC facility both 1 EA 7006.9 7006.9 Gross Charge Type: Pharmacy fentaNYL 250 mcg inj 5 mL Sol [INYO] 4717 CDM J3010 HCPCS 00409-9094-25 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy fentaNYL 250 mcg inj 5 mL Sol [INYO] 4717 CDM J3010 HCPCS 63323-0806-05 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy DOXOrubicin 2 mg/mL Sol 4718 CDM J9000 HCPCS 00143-9086-01 NDC facility both 25 ML 294 294 Gross Charge Type: Pharmacy DOXOrubicin 2 mg/mL IV Sol [INYO] 4718 CDM J9000 HCPCS 00703-5046-01 NDC facility both 25 ML 394.8 394.8 Gross Charge Type: Pharmacy CARBOplatin 450mg/ 45mL Sol [INYO] 4720 CDM J9045 HCPCS 16729-0295-34 NDC facility both 45 ML 546 546 Gross Charge Type: Pharmacy CISplatin 1 mg/mL IV Sol [INYO] 4721 CDM J9060 HCPCS 00703-5747-11 NDC facility both 50 ML 225 225 Gross Charge Type: Pharmacy CISplatin 1 mg/ mL 100 mL Sol [INYO] 4722 CDM J9060 HCPCS 00703-5748-11 NDC facility both 100 ML 338.52 338.52 Gross Charge Type: Pharmacy cyclophosphamide 500 mg Pow 4723 CDM J9075 HCPCS 70121-1238-01 NDC facility both 1 EA 1977.8 1977.8 Gross Charge Type: Pharmacy cyclophosphamide 500 mg IV Inj [INYO] 4723 CDM J9075 HCPCS 10019-0955-01 NDC facility both 1 EA 2197.5 2197.5 Gross Charge Type: Pharmacy gemcitabine 1 g IV Inj [INYO] 4725 CDM J9201 HCPCS 00002-7502-01 NDC facility both 1 EA 4445.7 4445.7 Gross Charge Type: Pharmacy irinotecan 20 mg/mL 2 mL Sol [INYO] 4727 CDM J9206 HCPCS 59923-0702-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy mitoMYcin 20 mg IV Inj [INYO] 4730 CDM J9280 HCPCS 55390-0252-01 NDC facility both 1 EA 1015.2 1015.2 Gross Charge Type: Pharmacy vinorelbine 10 mg/mL IV Sol [INYO] 4732 CDM J9390 HCPCS 00703-4183-01 NDC facility both 5 ML 845 845 Gross Charge Type: Pharmacy fosphenytoin (PE) 500 mg/10 mL Sol [INYO] 4735 CDM Q2009 HCPCS 00641-6137-10 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy fosphenytoin (PE) 500 mg/10 mL Inj Sol [INYO] 4735 CDM Q2009 HCPCS 00069-6001-21 NDC facility both 10 ML 358.27 358.27 Gross Charge Type: Pharmacy ondansetron 4 mg/2 mL Inj vial [INYO] 4736 CDM J2405 HCPCS 60505-6130-05 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy ondansetron 4 mg/2 mL Inj vial [INYO] 4736 CDM J2405 HCPCS 00409-4755-03 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy ondansetron 4 mg/2 mL Inj vial [INYO] 4736 CDM J2405 HCPCS 70860-0776-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy ondansetron 4 mg/2 mL Inj vial [INYO] 4736 CDM J2405 HCPCS 55150-0125-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy ondansetron 4 mg/2 mL Inj vial [INYO] 4736 CDM J2405 HCPCS 00641-6080-25 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy dacarbazine 100 mg Inj [INYO] 4745 CDM J9130 HCPCS 63323-0127-10 NDC facility both 1 EA 225 225 Gross Charge Type: Pharmacy methotrexate 25 mg/mL Inj Sol [INYO] 4746 CDM J9260 HCPCS 61703-0350-38 NDC facility both 2 ML 155 155 Gross Charge Type: Pharmacy promethazine 25 mg Tab [INYO] 4748 CDM Q0169 HCPCS 00904-7304-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB promethazine 25 mg Tab [INYO] 4748 CDM Q0169 HCPCS 00904-6461-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "47480 CHOLECYSTOTOMY OR CHOLECYSTOSTOMY, OPEN, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF CAL ProFee" 47480 CDM 982 RC 47480 HCPCS facility both 1534 1534 Gross Charge Type: NIHD_Hosp_Profee_Price "47480 CHOLECYSTOTOMY OR CHOLECYSTOSTOMY, OPEN, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF CAL ProFee" 47480 CDM 982 RC 47480 HCPCS facility both 1534 1534 Gross Charge Type: NIHD_Hosp_Profee_Price PHENobarbital 20 mg/5 mL Oral Elix [INYO] 4749 CDM 00603-1508-58 NDC facility both 473 ML 367.2 367.2 Gross Charge Type: Pharmacy "47490 CHOLECYSTOSTOMY, PERCUTANEOUS, COMPLETE PROCEDURE, INCLUDING IMAGING GUIDANCE, CATHETE ProFee" 47490 CDM 982 RC 47490 HCPCS facility both 615 615 Gross Charge Type: NIHD_Hosp_Profee_Price "47490 CHOLECYSTOSTOMY, PERCUTANEOUS, COMPLETE PROCEDURE, INCLUDING IMAGING GUIDANCE, CATHETE ProFee" 47490 CDM 982 RC 47490 HCPCS facility both 615 615 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cholangiogram Injection Procedure 475311 CDM 761 RC facility both TC 2441 2441 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cholangiogram Injection Procedure 475311 CDM 761 RC facility both TC 2441 2441 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cholangiogram Injection Procedure - Report 475312 CDM 972 RC 47531 HCPCS facility both 26 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cholangiogram Injection Procedure - Report 475312 CDM 972 RC 47531 HCPCS facility both 26 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biliary Drain Cath Placement Ext 475331 CDM 761 RC facility both TC 6513 6513 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biliary Drain Cath Placement Ext 475331 CDM 761 RC facility both TC 6513 6513 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biliary Drain Cath Exchange Int/Ext 475361 CDM 761 RC facility both TC 3719 3719 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biliary Drain Cath Exchange Int/Ext 475361 CDM 761 RC facility both TC 3719 3719 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biliary Drain Cath Exchange Int/Ext - Report 475362 CDM 982 RC 47536 HCPCS facility both 26 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biliary Drain Cath Exchange Int/Ext - Report 475362 CDM 982 RC 47536 HCPCS facility both 26 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biliary Drain Cath Removal 475371 CDM 761 RC facility both TC 2013 2013 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biliary Drain Cath Removal 475371 CDM 761 RC facility both TC 2013 2013 Gross Charge Type: NIHD_Hosp_Profee_Price riTUXimab 100 mg/10 mL IV Sol [INYO] 4755 CDM J9312 HCPCS 50242-0051-21 NDC facility both 10 ML 5637.12 5637.12 Gross Charge Type: Pharmacy "47550 BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY) (LIST SEPARATELY IN ADDITION TO CO ProFee" 47550 CDM 47550 HCPCS facility both 467 467 Gross Charge Type: NIHD_Hosp_Profee_Price "47550 BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY) (LIST SEPARATELY IN ADDITION TO CO ProFee" 47550 CDM 47550 HCPCS facility both 467 467 Gross Charge Type: NIHD_Hosp_Profee_Price riTUXimab 500 mg/50 mL Sol [INYO] 4756 CDM J9312 HCPCS 50242-0053-06 NDC facility both 50 ML 15200 15200 Gross Charge Type: Pharmacy "47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY ProFee" 47562 CDM 982 RC 47562 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY ProFee" 47562 CDM 982 RC 47562 HCPCS facility both 1211 1211 Gross Charge Type: NIHD_Hosp_Profee_Price "47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY ProFee" 47563 CDM 982 RC 47563 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY ProFee" 47563 CDM 982 RC 47563 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT ProFee" 47564 CDM 982 RC 47564 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT ProFee" 47564 CDM 982 RC 47564 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price dextromethorphan-guaifenesin 20 mg-200 mg/10 mL UD [INYO] 4758 CDM 00121-1276-00 NDC facility both 10 ML 17.29 17.29 Gross Charge Type: Pharmacy dextromethorphan-guaifenesin 20 mg-200 mg/10 mL UD [INYO] 4758 CDM 00121-0638-10 NDC facility both 10 ML 11.7 11.7 Gross Charge Type: Pharmacy 47600 CHOLECYSTECTOMY; ProFee 47600 CDM 982 RC 47600 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price 47600 CHOLECYSTECTOMY; ProFee 47600 CDM 982 RC 47600 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price 47605 CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY ProFee 47605 CDM 982 RC 47605 HCPCS facility both 2247 2247 Gross Charge Type: NIHD_Hosp_Profee_Price 47605 CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY ProFee 47605 CDM 982 RC 47605 HCPCS facility both 2247 2247 Gross Charge Type: NIHD_Hosp_Profee_Price oxyCODONE 10 mg ER Tab [INYO] 4762 CDM 59011-0410-20 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE 10 mg ER Tab [INYO] 4762 CDM 59011-0410-10 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB magnesium sulfate 50% Sol 10 mL [INYO] 4764 CDM J3475 HCPCS 63323-0064-11 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy magnesium sulfate 50% Sol 10 mL [INYO] 4764 CDM J3475 HCPCS 63323-0064-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy furosemide 100 mg/ 10 mL Inj Sol [INYO] 4765 CDM J1940 HCPCS 36000-0284-25 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy furosemide 100 mg/ 10 mL Inj Sol [INYO] 4765 CDM J1940 HCPCS 25021-0311-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy furosemide 100 mg/ 10 mL Inj Sol [INYO] 4765 CDM J1940 HCPCS 00409-6102-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy magnesium sulfate 50% Inj Sol 2 mL [INYO] 4766 CDM J3475 HCPCS 63323-0064-03 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy furosemide 40 mg/ 4 mL Inj Sol [INYO] 4770 CDM J1940 HCPCS 36000-0283-25 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy furosemide 40 mg/ 4 mL Inj Sol [INYO] 4770 CDM J1940 HCPCS 16729-0501-43 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy furosemide 40 mg/ 4 mL Inj Sol [INYO] 4770 CDM J1940 HCPCS 23155-0473-42 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy furosemide 40 mg/ 4 mL Inj Sol [INYO] 4770 CDM J1940 HCPCS 00409-6102-04 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy albuterol-ipratropium 100 mcg-20 mcg/inh Aer [INYO] 4772 CDM 00597-0024-02 NDC facility both 1 EA 1791.09 1791.09 Gross Charge Type: Pharmacy | NDC EA = 4 INH famotidine 20 mg/50 mL Premix IVPB Sol [INYO] 4773 CDM 00338-5197-41 NDC facility both 50 ML 265 265 Gross Charge Type: Pharmacy ketorolac 30 mg/mL Inj Sol [INYO] 4777 CDM J1885 HCPCS 00409-3795-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ketorolac 30 mg/mL Sol 4777 CDM J1885 HCPCS 72266-0118-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ketorolac 30 mg/mL Inj Sol [INYO] 4777 CDM J1885 HCPCS 63323-0162-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ketorolac 30 mg/mL Inj Sol [INYO] 4777 CDM J1885 HCPCS 00338-0072-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ketorolac 30 mg/mL Inj Sol [INYO] 4777 CDM J1885 HCPCS 72611-0722-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ketorolac 30 mg/mL Inj Sol [INYO] 4777 CDM J1885 HCPCS 47781-0584-68 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy irbesartan 150 mg Tab [INYO] 4783 CDM 50268-0441-15 NDC facility both 1 EA 18.74 18.74 Gross Charge Type: Pharmacy | NDC EA = 1 TAB irbesartan 150 mg Tab [INYO] 4783 CDM 00024-5851-30 NDC facility both 1 EA 47.69 47.69 Gross Charge Type: Pharmacy | NDC EA = 1 TAB irbesartan 150 mg Tab [INYO] 4783 CDM 59746-0448-90 NDC facility both 1 EA 18.42 18.42 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Chloraseptic Spray 1.4% [INYO] 4784 CDM 78112-0694-80 NDC facility both 1 EA 11.64 11.64 Gross Charge Type: Pharmacy | NDC EA = 20 SPRAYS NEEDLE SPINAL 20G X5 STERILE 4785111 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SPINAL 20G X5 STERILE 4785111 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price granisetron 1 mg/mL Sol [INYO] 4793 CDM J1626 HCPCS 63323-0318-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy granisetron 1 mg/mL IV Sol [INYO] 4793 CDM J1626 HCPCS 67457-0863-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy granisetron 1 mg/mL IV Sol [INYO] 4793 CDM J1626 HCPCS 17478-0546-02 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy alteplase 100 mg Premix IVPB [INYO] 4794 CDM J2997 HCPCS 50242-0085-27 NDC facility both 1 EA 26401.08 26401.08 Gross Charge Type: Pharmacy cefTRIAXone 1 g Inj [INYO] 4795 CDM J0696 HCPCS 60505-6148-04 NDC facility both 1 EA 367.59 367.59 Gross Charge Type: Pharmacy cefTRIAXone 1 g Inj [INYO] 4795 CDM J0696 HCPCS 44567-0701-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTRIAXone 1 g Inj [INYO] 4795 CDM J0696 HCPCS 00409-7333-04 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy diazepam 10 mg/2 mL Inj Sol [INYO] 4796 CDM J3360 HCPCS 00409-1273-32 NDC facility both 2 ML 251.57 251.57 Gross Charge Type: Pharmacy buPROPion 150 mg ER Tab [INYO] 4797 CDM 00904-6585-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buPROPion 150 mg/12 hours Tab [inyo] 4797 CDM 00904-7214-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB midazolam 2 mg/2 mL Sol [INYO] 4798 CDM J2250 HCPCS 23155-0600-41 NDC facility both 2 ML 170 170 Gross Charge Type: Pharmacy midazolam 2 mg/2 mL Sol [INYO] 4798 CDM J2250 HCPCS 00641-6057-25 NDC facility both 2 ML 170 170 Gross Charge Type: Pharmacy midazolam 2 mg/2 mL Sol [INYO] 4798 CDM J2250 HCPCS 72611-0741-25 NDC facility both 2 ML 170 170 Gross Charge Type: Pharmacy midazolam 5 mg/5 mL Inj 5 mL Sol [INYO] 4800 CDM J2250 HCPCS 00641-6059-10 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy midazolam 5 mg/5 mL Inj 5 mL Sol [INYO] 4800 CDM J2250 HCPCS 63323-0411-25 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy glycopyrrolate 1 mg/5mL Inj Sol [INYO] 4804 CDM 70700-0167-25 NDC facility both 5 ML 358.19 358.19 Gross Charge Type: Pharmacy glycopyrrolate 1 mg/5mL Inj Sol [INYO] 4804 CDM 70069-0013-25 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy glycopyrrolate 1 mg/5mL Inj Sol [INYO] 4804 CDM 71288-0408-06 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy phytonadione 10 mg/mL Inj Sol [INYO] 4806 CDM J3430 HCPCS 43598-0405-16 NDC facility both 1 ML 330 330 Gross Charge Type: Pharmacy phytonadione 10 mg/mL Inj Sol [INYO] 4806 CDM J3430 HCPCS 00409-9158-01 NDC facility both 1 ML 330 330 Gross Charge Type: Pharmacy hydrOXYzine hydrochloride 25 mg/mL IM Sol [INYO] 4807 CDM J3410 HCPCS 00517-4201-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy CT Biopsy Pancreas 481022 CDM 761 RC facility both TC 2316 2316 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Pancreas 481022 CDM 761 RC facility both TC 2316 2316 Gross Charge Type: NIHD_Hosp_Profee_Price DOXOrubicin liposomal 2 mg/mL IV Dispersion [INYO] 4813 CDM Q2050 HCPCS 59676-0960-01 NDC facility both 10 ML 7493.75 7493.75 Gross Charge Type: Pharmacy midazolam 25 mg/5 mL [INYO] 4815 CDM J2250 HCPCS 25021-0661-05 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy midazolam 25 mg/5 mL [INYO] 4815 CDM J2250 HCPCS 23155-0601-41 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy beractant 25 mg/mL intratracheal Sol [INYO] 4818 CDM 00074-1040-04 NDC facility both 4 ML 2298 2298 Gross Charge Type: Pharmacy sodium bicarbonate 650 mg Tab [INYO] 4819 CDM 66553-0008-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sodium bicarbonate 650 mg Tab [INYO] 4819 CDM 00223-1721-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrALAZINE 50 mg Tab [INYO] 4820 CDM 51079-0076-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrALAZINE 50 mg Tab [INYO] 4820 CDM 00904-6442-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB fluorescein 10% Sol 4824 CDM 14789-0122-05 NDC facility both 5 ML 2124 2124 Gross Charge Type: Pharmacy fluorescein 10% IV Sol 5 mL [INYO] 4824 CDM 00065-0092-65 NDC facility both 5 ML 447.16 447.16 Gross Charge Type: Pharmacy fluorescein 10% IV Sol 5 mL [INYO] 4824 CDM 17478-0253-10 NDC facility both 5 ML 365 365 Gross Charge Type: Pharmacy midazolam 2 mg/mL Syr [inyo] 4825 CDM 00054-3566-99 NDC facility both 5 ML 53.88 53.88 Gross Charge Type: Pharmacy midazolam 2 mg/mL ORAL Syr UD [INYO] 4825 CDM 68094-0764-62 NDC facility both 5 ML 36.66 36.66 Gross Charge Type: Pharmacy midazolam 2 mg/mL ORAL Syr UD [INYO] 4825 CDM 60687-0576-86 NDC facility both 5 ML 37 37 Gross Charge Type: Pharmacy dexrazoxane 250 mg IV Inj [INYO] 4826 CDM J1190 HCPCS 00013-8717-62 NDC facility both 1 EA 845.58 845.58 Gross Charge Type: Pharmacy triamcinolone acetonide 40 mg/mL Inj Susp [INYO] 4827 CDM J3301 HCPCS 00703-0241-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy triamcinolone acetonide 40 mg/mL Inj Susp [INYO] 4827 CDM J3301 HCPCS 00003-0293-05 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy triamcinolone acetonide 40 mg/mL Inj Susp [INYO] 4827 CDM J3301 HCPCS 70121-1049-02 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy amiodarone 150 mg/3mL IV Sol [INYO] 4831 CDM J0282 HCPCS 00143-9875-25 NDC facility both 3 ML 235 235 Gross Charge Type: Pharmacy amiodarone 150 mg/3mL IV Sol [INYO] 4831 CDM J0282 HCPCS 63323-0616-03 NDC facility both 3 ML 235 235 Gross Charge Type: Pharmacy amiodarone 50 mg/mL Sol [inyo] 4831 CDM J0282 HCPCS 67457-0153-03 NDC facility both 3 ML 235 235 Gross Charge Type: Pharmacy amiodarone 150 mg/3mL IV Sol [INYO] 4831 CDM J0282 HCPCS 00143-9875-10 NDC facility both 3 ML 235 235 Gross Charge Type: Pharmacy clindamycin Top 1% Sol [INYO] 4834 CDM 59762-3728-01 NDC facility both 1 EA 235.08 235.08 Gross Charge Type: Pharmacy | NDC EA = 30 APP hepatitis A adult vaccine 1440 units/mL PF IM Susp [INYO] 4837 CDM 58160-0826-52 NDC facility both 1 ML 687.59 687.59 Gross Charge Type: Pharmacy hepatitis A adult vaccine 1440 units/mL PF IM Susp [INYO] 4837 CDM 58160-0826-11 NDC facility both 1 ML 700.81 700.81 Gross Charge Type: Pharmacy hepatitis B immune globulin IM Sol 1 mL [INYO] 4860 CDM 59730-4202-01 NDC facility both 1 ML 1520 1520 Gross Charge Type: Pharmacy podophyllum resin Top 25% Sol [INYO] 4869 CDM 00574-0601-15 NDC facility both 1 EA 490 490 Gross Charge Type: Pharmacy | NDC EA = 15 APP enoxaparin 100 mg/mL SubQ Sol [INYO] 4875 CDM J1650 HCPCS 71288-0410-89 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 100 mg/mL SubQ Sol [INYO] 4875 CDM J1650 HCPCS 00781-3268-69 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 100 mg/mL SubQ Sol [INYO] 4875 CDM J1650 HCPCS 00548-5635-00 NDC facility both 1 ML 528 528 Gross Charge Type: Pharmacy enoxaparin 100 mg/mL SubQ Sol [INYO] 4875 CDM J1650 HCPCS 60505-0795-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 30 mg/0.3 mL SC Sol [INYO] 4876 CDM J1650 HCPCS 71288-0432-81 NDC facility both 0.3 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 30 mg/0.3 mL SC Sol [INYO] 4876 CDM J1650 HCPCS 00548-5631-00 NDC facility both 0.3 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 30 mg/0.3 mL SC Sol [INYO] 4876 CDM J1650 HCPCS 71288-0432-92 NDC facility both 0.3 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 30 mg/0.3 mL SC Sol [INYO] 4876 CDM J1650 HCPCS 00548-5601-00 NDC facility both 0.3 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 40 mg/0.4 mL Sol [INYO] 4877 CDM J1650 HCPCS 71288-0433-92 NDC facility both 0.4 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 40 mg/0.4 mL SC Sol [INYO] 4877 CDM J1650 HCPCS 71288-0433-83 NDC facility both 0.4 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 40 mg/0.4 mL SC Sol [INYO] 4877 CDM J1650 HCPCS 00548-5632-00 NDC facility both 0.4 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 40 mg/0.4 mL SC Sol [INYO] 4877 CDM J1650 HCPCS 60505-0792-00 NDC facility both 0.4 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 40 mg/0.4 mL SC Sol [INYO] 4877 CDM J1650 HCPCS 71288-0410-83 NDC facility both 0.4 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 40 mg/0.4 mL SC Sol [INYO] 4877 CDM J1650 HCPCS 00548-5602-00 NDC facility both 0.4 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 60 mg/0.6 mL SC Sol [INYO] 4878 CDM J1650 HCPCS 00548-5603-00 NDC facility both 0.6 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 80 mg/0.8 mL Sol [INYO] 4879 CDM J1650 HCPCS 71288-0435-87 NDC facility both 0.8 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 80 mg/0.8 mL SC Sol [INYO] 4879 CDM J1650 HCPCS 71288-0410-87 NDC facility both 0.8 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 80 mg/0.8 mL SC Sol [INYO] 4879 CDM J1650 HCPCS 00548-5634-00 NDC facility both 0.8 ML 422.4 422.4 Gross Charge Type: Pharmacy enoxaparin 80 mg/0.8 mL SC Sol [INYO] 4879 CDM J1650 HCPCS 60505-0794-04 NDC facility both 0.8 ML 235 235 Gross Charge Type: Pharmacy "49000 EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR WITHOUT BIOPSY(S) (SEPARATE PROC ProFee" 49000 CDM 982 RC 49000 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price "49000 EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR WITHOUT BIOPSY(S) (SEPARATE PROC ProFee" 49000 CDM 982 RC 49000 HCPCS facility both 1560 1560 Gross Charge Type: NIHD_Hosp_Profee_Price 49002 REOPENING OF RECENT LAPAROTOMY ProFee 49002 CDM 982 RC 49002 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price 49002 REOPENING OF RECENT LAPAROTOMY ProFee 49002 CDM 982 RC 49002 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price 49082 ABDOMINAL PARACENTESIS CHARGE 49082 CDM 761 RC facility both 1111 1111 Gross Charge Type: NIHD_Hosp_Profee_Price 49082 ABDOMINAL PARACENTESIS CHARGE 49082 CDM 761 RC facility both 1111 1111 Gross Charge Type: NIHD_Hosp_Profee_Price 49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance 490821 CDM 521 RC 49082 HCPCS facility both 887 887 Gross Charge Type: NIHD_RHC_Price "49082 INCISION PROC ON THE ABDM, PERITONEUM, AND OMENTUM TechFee" 490822 CDM 450 RC facility both 1111 1111 Gross Charge Type: NIHD_Hosp_Profee_Price "49082 INCISION PROC ON THE ABDM, PERITONEUM, AND OMENTUM TechFee" 490822 CDM 450 RC facility both 1111 1111 Gross Charge Type: NIHD_Hosp_Profee_Price 49082 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE ProFee 490823 CDM 982 RC 49082 HCPCS facility both 638 638 Gross Charge Type: NIHD_Hosp_Profee_Price 49082 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE ProFee 490823 CDM 982 RC 49082 HCPCS facility both 638 638 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 ED ABDOMINAL PARACENTESIS W GUIDE CHARGE 490831 CDM 450 RC facility both 1722 1722 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 ED ABDOMINAL PARACENTESIS W GUIDE CHARGE 490831 CDM 450 RC facility both 1722 1722 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CHARGE 490832 CDM 761 RC facility both 1722 1722 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CHARGE 490832 CDM 761 RC facility both 1722 1722 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE ProFee 490833 CDM 982 RC 49083 HCPCS facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE ProFee 490833 CDM 982 RC 49083 HCPCS facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price US Paracentesis - Report 490834 CDM 982 RC 49083 HCPCS facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price US Paracentesis - Report 490834 CDM 982 RC 49083 HCPCS facility both 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price US Paracentesis 490835 CDM 320 RC facility both TC 1503 1503 Gross Charge Type: NIHD_Hosp_Profee_Price US Paracentesis 490835 CDM 320 RC facility both TC 1503 1503 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 US Paracentesis 490836 CDM 320 RC facility both TC 1503 1503 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 US Paracentesis 490836 CDM 320 RC facility both TC 1503 1503 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 US Paracentesis PROFEE 490837 CDM 982 RC 49083 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price 49083 US Paracentesis PROFEE 490837 CDM 982 RC 49083 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price "49084 PERITONEAL LAVAGE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED ProFee" 49084 CDM 982 RC 49084 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "49084 PERITONEAL LAVAGE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED ProFee" 49084 CDM 982 RC 49084 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT MED FOLD OVER W/ FOAM 4911102 CDM 271 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT MED FOLD OVER W/ FOAM 4911102 CDM 271 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Retroperitoneal Abdomen 491801 CDM 761 RC facility both TC 1697 1697 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Retroperitoneal Abdomen 491801 CDM 761 RC facility both TC 1697 1697 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Retroperitoneal Abdomen - Report 491802 CDM 982 RC 49180 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price CT Biopsy Retroperitoneal Abdomen - Report 491802 CDM 982 RC 49180 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Retroperitoneal Abdomen 491803 CDM 761 RC facility both TC 1697 1697 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Retroperitoneal Abdomen 491803 CDM 761 RC facility both TC 1697 1697 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Retroperitoneal Abdomen - Report 491804 CDM 982 RC 49180 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Retroperitoneal Abdomen - Report 491804 CDM 982 RC 49180 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Retroperitoneal Abdomen 491805 CDM 320 RC facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Retroperitoneal Abdomen 491805 CDM 320 RC facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Retroperitoneal Abdomen - Report 491806 CDM 982 RC 49180 HCPCS facility both 26 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Retroperitoneal Abdomen - Report 491806 CDM 982 RC 49180 HCPCS facility both 26 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price "49250 UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE) ProFee" 49250 CDM 982 RC 49250 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price "49250 UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE) ProFee" 49250 CDM 982 RC 49250 HCPCS facility both 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price "49255 OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM (SEPARATE PROCEDURE) ProFee" 49255 CDM 982 RC 49255 HCPCS facility both 1660 1660 Gross Charge Type: NIHD_Hosp_Profee_Price "49255 OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM (SEPARATE PROCEDURE) ProFee" 49255 CDM 982 RC 49255 HCPCS facility both 1660 1660 Gross Charge Type: NIHD_Hosp_Profee_Price "49320 LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION ProFee" 49320 CDM 982 RC 49320 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "49320 LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION ProFee" 49320 CDM 982 RC 49320 HCPCS facility both 1274 1274 Gross Charge Type: NIHD_Hosp_Profee_Price "49321 LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE) ProFee" 49321 CDM 982 RC 49321 HCPCS facility both 516 516 Gross Charge Type: NIHD_Hosp_Profee_Price "49321 LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE) ProFee" 49321 CDM 982 RC 49321 HCPCS facility both 516 516 Gross Charge Type: NIHD_Hosp_Profee_Price "49322 LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR ProFee" 49322 CDM 982 RC 49322 HCPCS facility both 640 640 Gross Charge Type: NIHD_Hosp_Profee_Price "49322 LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR ProFee" 49322 CDM 982 RC 49322 HCPCS facility both 640 640 Gross Charge Type: NIHD_Hosp_Profee_Price "49329 UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM ProFee" 49329 CDM 982 RC 49329 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "49329 UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM ProFee" 49329 CDM 982 RC 49329 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Visceral Fluid w/Cath Perc - Report 494051 CDM 975 RC 49405 HCPCS facility both 26 349 349 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Visceral Fluid w/Cath Perc - Report 494051 CDM 975 RC 49405 HCPCS facility both 26 349 349 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Visceral Fluid w/Cath Perc 494052 CDM 761 RC facility both TC 3352 3352 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Visceral Fluid w/Cath Perc 494052 CDM 761 RC facility both TC 3352 3352 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Visceral Fluid w/Cath Perc - Report 494053 CDM 975 RC 49405 HCPCS facility both 26 349 349 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Visceral Fluid w/Cath Perc - Report 494053 CDM 975 RC 49405 HCPCS facility both 26 349 349 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Visceral Fluid w/Cath Perc 494054 CDM 761 RC facility both TC 3352 3352 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Visceral Fluid w/Cath Perc 494054 CDM 761 RC facility both TC 3352 3352 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Per/Retr Fld w/Cath Perc 494061 CDM 761 RC facility both TC 2661 2661 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Per/Retr Fld w/Cath Perc 494061 CDM 761 RC facility both TC 2661 2661 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Per/Retr Fld w/Cath Perc - Report 494062 CDM 982 RC 49406 HCPCS facility both 26 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price CT Drain Per/Retr Fld w/Cath Perc - Report 494062 CDM 982 RC 49406 HCPCS facility both 26 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Per/Retr Fld w/Cath Perc - Report 494063 CDM 982 RC 49406 HCPCS facility both 26 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Per/Retr Fld w/Cath Perc - Report 494063 CDM 982 RC 49406 HCPCS facility both 26 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Per/Retr Fld w/Cath Perc 494064 CDM 761 RC facility both TC 2661 2661 Gross Charge Type: NIHD_Hosp_Profee_Price US Drain Per/Retr Fld w/Cath Perc 494064 CDM 761 RC facility both TC 2661 2661 Gross Charge Type: NIHD_Hosp_Profee_Price US Intraperitoneal Tunnel Cath Insertion 494181 CDM 761 RC facility both TC 4138 4138 Gross Charge Type: NIHD_Hosp_Profee_Price US Intraperitoneal Tunnel Cath Insertion 494181 CDM 761 RC facility both TC 4138 4138 Gross Charge Type: NIHD_Hosp_Profee_Price US Intraperitoneal Tunnel Cath Insertion - Report 494182 CDM 975 RC 49418 HCPCS facility both 26 409 409 Gross Charge Type: NIHD_Hosp_Profee_Price US Intraperitoneal Tunnel Cath Insertion - Report 494182 CDM 975 RC 49418 HCPCS facility both 26 409 409 Gross Charge Type: NIHD_Hosp_Profee_Price 49422 REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER ProFee 49422 CDM 982 RC 49422 HCPCS facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price 49422 REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER ProFee 49422 CDM 982 RC 49422 HCPCS facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Liver 494501 CDM 361 RC facility both 1812 1812 Gross Charge Type: NIHD_Hosp_Profee_Price XR Biopsy Liver 494501 CDM 361 RC facility both 1812 1812 Gross Charge Type: NIHD_Hosp_Profee_Price XR Gastrostomy Tube Replacement 494503 CDM 361 RC facility both TC 1582 1582 Gross Charge Type: NIHD_Hosp_Profee_Price XR Gastrostomy Tube Replacement 494503 CDM 361 RC facility both TC 1582 1582 Gross Charge Type: NIHD_Hosp_Profee_Price XR Gastrostomy Tube Replacement - Report 494504 CDM 960 RC 49450 HCPCS facility both 26 117 117 Gross Charge Type: NIHD_Hosp_Profee_Price XR Gastrostomy Tube Replacement - Report 494504 CDM 960 RC 49450 HCPCS facility both 26 117 117 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tube Replace D or J w/ Fluoro w/ Cnt 494511 CDM 320 RC facility both TC 1579 1579 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tube Replace D or J w/ Fluoro w/ Cnt 494511 CDM 320 RC facility both TC 1579 1579 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tube Replace D or J w/ Fluoro w/ Cnt - Report 494512 CDM 972 RC 49451 HCPCS facility both 26 130 130 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tube Replace D or J w/ Fluoro w/ Cnt - Report 494512 CDM 972 RC 49451 HCPCS facility both 26 130 130 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Contrast for Tube Eval 494651 CDM 320 RC facility both TC 597 597 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Contrast for Tube Eval 494651 CDM 320 RC facility both TC 597 597 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Contrast for Tube Eval - Report 494652 CDM 975 RC 49465 HCPCS facility both 26 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Contrast for Tube Eval - Report 494652 CDM 975 RC 49465 HCPCS facility both 26 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price "49505 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ProFee" 49505 CDM 982 RC 49505 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price "49505 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ProFee" 49505 CDM 982 RC 49505 HCPCS facility both 1086 1086 Gross Charge Type: NIHD_Hosp_Profee_Price "49507 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED ProFee" 49507 CDM 982 RC 49507 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "49507 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED ProFee" 49507 CDM 982 RC 49507 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "49520 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE ProFee" 49520 CDM 982 RC 49520 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "49520 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE ProFee" 49520 CDM 982 RC 49520 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "49521 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED ProFee" 49521 CDM 982 RC 49521 HCPCS facility both 1447 1447 Gross Charge Type: NIHD_Hosp_Profee_Price "49521 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED ProFee" 49521 CDM 982 RC 49521 HCPCS facility both 1447 1447 Gross Charge Type: NIHD_Hosp_Profee_Price "49525 REPAIR INGUINAL HERNIA, SLIDING, ANY AGE ProFee" 49525 CDM 982 RC 49525 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price "49525 REPAIR INGUINAL HERNIA, SLIDING, ANY AGE ProFee" 49525 CDM 982 RC 49525 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price "49550 REPAIR INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE ProFee" 49550 CDM 982 RC 49550 HCPCS facility both 1001 1001 Gross Charge Type: NIHD_Hosp_Profee_Price "49550 REPAIR INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE ProFee" 49550 CDM 982 RC 49550 HCPCS facility both 1001 1001 Gross Charge Type: NIHD_Hosp_Profee_Price "49553 REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED ProFee" 49553 CDM 982 RC 49553 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "49553 REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED ProFee" 49553 CDM 982 RC 49553 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price 49557 REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED ProFee 49557 CDM 982 RC 49557 HCPCS facility both 1292 1292 Gross Charge Type: NIHD_Hosp_Profee_Price 49557 REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED ProFee 49557 CDM 982 RC 49557 HCPCS facility both 1292 1292 Gross Charge Type: NIHD_Hosp_Profee_Price "49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigel" 49591 CDM 982 RC 49591 HCPCS facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price "49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigel" 49591 CDM 982 RC 49591 HCPCS facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price "49592 Repair AA hernia, initial, <3cm, incarcerated" 49592 CDM 982 RC 49592 HCPCS facility both 685 685 Gross Charge Type: NIHD_Hosp_Profee_Price "49592 Repair AA hernia, initial, <3cm, incarcerated" 49592 CDM 982 RC 49592 HCPCS facility both 685 685 Gross Charge Type: NIHD_Hosp_Profee_Price "49593 repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigel" 49593 CDM 982 RC 49593 HCPCS facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price "49593 repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigel" 49593 CDM 982 RC 49593 HCPCS facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price "49594 Laparoscopic unbilical hernia repar 3-10 cm, incarcerated or strangulated" 49594 CDM 982 RC 49594 HCPCS facility both 1073 1073 Gross Charge Type: NIHD_Hosp_Profee_Price "49594 Laparoscopic unbilical hernia repar 3-10 cm, incarcerated or strangulated" 49594 CDM 982 RC 49594 HCPCS facility both 1073 1073 Gross Charge Type: NIHD_Hosp_Profee_Price 49596 RPR AA HRN 1ST > 10 NCR/STRN 49596 CDM 49596 HCPCS facility both 2951 2951 Gross Charge Type: NIHD_Hosp_Profee_Price 49596 RPR AA HRN 1ST > 10 NCR/STRN 49596 CDM 49596 HCPCS facility both 2951 2951 Gross Charge Type: NIHD_Hosp_Profee_Price 49614 RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED ProFee Charge 49614 CDM 982 RC 49614 HCPCS facility both 1701 1701 Gross Charge Type: NIHD_Hosp_Profee_Price 49614 RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED ProFee Charge 49614 CDM 982 RC 49614 HCPCS facility both 1701 1701 Gross Charge Type: NIHD_Hosp_Profee_Price "49650 LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA ProFee" 49650 CDM 982 RC 49650 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "49650 LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA ProFee" 49650 CDM 982 RC 49650 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "49651 LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA ProFee" 49651 CDM 982 RC 49651 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "49651 LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA ProFee" 49651 CDM 982 RC 49651 HCPCS facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price "49659 UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY ProFee" 49659 CDM 982 RC 49659 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "49659 UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY ProFee" 49659 CDM 982 RC 49659 HCPCS facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price "49900 SUTURE, SECONDARY, OF ABDOMINAL WALL FOR EVISCERATION OR DEHISCENCE ProFee" 49900 CDM 982 RC 49900 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "49900 SUTURE, SECONDARY, OF ABDOMINAL WALL FOR EVISCERATION OR DEHISCENCE ProFee" 49900 CDM 982 RC 49900 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "49999 UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM ProFee" 49999 CDM 982 RC 49999 HCPCS facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price "49999 UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM ProFee" 49999 CDM 982 RC 49999 HCPCS facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price "50130 PYELOTOMY; WITH REMOVAL OF CALCULUS (PYELOLITHOTOMY, PELVIOLITHOTOMY, INCLUDING COAGUL ProFee" 50130 CDM 982 RC 50130 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price "50130 PYELOTOMY; WITH REMOVAL OF CALCULUS (PYELOLITHOTOMY, PELVIOLITHOTOMY, INCLUDING COAGUL ProFee" 50130 CDM 982 RC 50130 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Renal 502001 CDM 402 RC facility both TC 2542 2542 Gross Charge Type: NIHD_Hosp_Profee_Price US Biopsy Renal 502001 CDM 402 RC facility both TC 2542 2542 Gross Charge Type: NIHD_Hosp_Profee_Price "50389 REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDW ProFee" 50389 CDM 982 RC 50389 HCPCS facility both 160 160 Gross Charge Type: NIHD_Hosp_Profee_Price "50389 REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDW ProFee" 50389 CDM 982 RC 50389 HCPCS facility both 160 160 Gross Charge Type: NIHD_Hosp_Profee_Price CT Aspiration/Inject Renal Cyst/Pelvis - Report 503901 CDM 972 RC 50390 HCPCS facility both 26 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price CT Aspiration/Inject Renal Cyst/Pelvis - Report 503901 CDM 972 RC 50390 HCPCS facility both 26 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price CT Aspiration/Inject Renal Cyst/Pelvis 503902 CDM 350 RC facility both TC 2093 2093 Gross Charge Type: NIHD_Hosp_Profee_Price CT Aspiration/Inject Renal Cyst/Pelvis 503902 CDM 350 RC facility both TC 2093 2093 Gross Charge Type: NIHD_Hosp_Profee_Price US Aspiration/Inject Renal Cyst/Pelvis 503903 CDM 402 RC facility both TC 2093 2093 Gross Charge Type: NIHD_Hosp_Profee_Price US Aspiration/Inject Renal Cyst/Pelvis 503903 CDM 402 RC facility both TC 2093 2093 Gross Charge Type: NIHD_Hosp_Profee_Price clindamycin 1500 mg/100 mL Oral Liq [INYO] 5040 CDM 59762-0016-01 NDC facility both 100 ML 260 260 Gross Charge Type: Pharmacy clindamycin 75 mg/5 mL Pow [inyo] 5040 CDM 23155-0603-51 NDC facility both 100 ML 260 260 Gross Charge Type: Pharmacy "50400 PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL PELVIS, WITH OR WITHOUT ProFee" 50400 CDM 982 RC 50400 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price "50400 PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ON RENAL PELVIS, WITH OR WITHOUT ProFee" 50400 CDM 982 RC 50400 HCPCS facility both 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price 50431 XR Nephrostogram Through Existing Access 50431 CDM 761 RC facility both TC 2032 2032 Gross Charge Type: NIHD_Hosp_Profee_Price 50431 XR Nephrostogram Through Existing Access 50431 CDM 761 RC facility both TC 2032 2032 Gross Charge Type: NIHD_Hosp_Profee_Price 50431 XR Nephrostogram Through Existing Access PROFEE 504311 CDM 982 RC 50431 HCPCS facility both 26 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price 50431 XR Nephrostogram Through Existing Access PROFEE 504311 CDM 982 RC 50431 HCPCS facility both 26 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price "50432 PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AN ProFee" 50432 CDM 982 RC 50432 HCPCS facility both 300 300 Gross Charge Type: NIHD_Hosp_Profee_Price "50432 PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AN ProFee" 50432 CDM 982 RC 50432 HCPCS facility both 300 300 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephrostomy Cath Plcmt 504321 CDM 761 RC facility both TC 2902 2902 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephrostomy Cath Plcmt 504321 CDM 761 RC facility both TC 2902 2902 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephrostomy Cath Plcmt - Report 504322 CDM 972 RC 50432 HCPCS facility both 26 638 638 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephrostomy Cath Plcmt - Report 504322 CDM 972 RC 50432 HCPCS facility both 26 638 638 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephroureteral Cath Rem/Replace Lt 504351 CDM 761 RC facility both TCLT 2074 2074 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephroureteral Cath Rem/Replace Lt 504351 CDM 761 RC facility both TCLT 2074 2074 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephroureteral Cath Rem/Replace Lt - Report 504352 CDM 982 RC 50435 HCPCS facility both 26LT 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephroureteral Cath Rem/Replace Lt - Report 504352 CDM 982 RC 50435 HCPCS facility both 26LT 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephroureteral Cath Rem/Replace Rt 504353 CDM 761 RC facility both TCRT 2074 2074 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephroureteral Cath Rem/Replace Rt 504353 CDM 761 RC facility both TCRT 2074 2074 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephroureteral Cath Rem/Replace Rt - Report 504354 CDM 982 RC 50435 HCPCS facility both 26RT 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephroureteral Cath Rem/Replace Rt - Report 504354 CDM 982 RC 50435 HCPCS facility both 26RT 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price BLEDSOE ARC 2.0 SHOULDER BRACE W/PILLOW 5050000 CDM 274 RC L3670 HCPCS facility both 147 147 Gross Charge Type: NIHD_RHC_Price BLEDSOE ARC 2.0 SHOULDER BRACE W/PILLOW 5050000 CDM 274 RC L3670 HCPCS facility both 147 147 Gross Charge Type: NIHD_Clinic_Price BLEDSOE ARC 2.0 SHOULDER BRACE W/PILLOW 5050000 CDM 274 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price BLEDSOE ARC 2.0 SHOULDER BRACE W/PILLOW 5050000 CDM 274 RC facility both 147 147 Gross Charge Type: NIHD_Hosp_Profee_Price "50543 LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY ProFee" 50543 CDM 982 RC 50543 HCPCS facility both 2632 2632 Gross Charge Type: NIHD_Hosp_Profee_Price "50543 LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY ProFee" 50543 CDM 982 RC 50543 HCPCS facility both 2632 2632 Gross Charge Type: NIHD_Hosp_Profee_Price "50544 LAPAROSCOPY, SURGICAL; PYELOPLASTY ProFee" 50544 CDM 982 RC 50544 HCPCS facility both 2199 2199 Gross Charge Type: NIHD_Hosp_Profee_Price "50544 LAPAROSCOPY, SURGICAL; PYELOPLASTY ProFee" 50544 CDM 982 RC 50544 HCPCS facility both 2199 2199 Gross Charge Type: NIHD_Hosp_Profee_Price "50590 LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE ProFee" 50590 CDM 982 RC 50590 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price "50590 LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE ProFee" 50590 CDM 982 RC 50590 HCPCS facility both 1061 1061 Gross Charge Type: NIHD_Hosp_Profee_Price 50610 URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER ProFee 50610 CDM 982 RC 50610 HCPCS facility both 1663 1663 Gross Charge Type: NIHD_Hosp_Profee_Price 50610 URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER ProFee 50610 CDM 982 RC 50610 HCPCS facility both 1663 1663 Gross Charge Type: NIHD_Hosp_Profee_Price "50715 URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER FOR RETROPERITONEAL FIBROSIS ProFee" 50715 CDM 50715 HCPCS facility both 1773 1773 Gross Charge Type: NIHD_Hosp_Profee_Price "50715 URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER FOR RETROPERITONEAL FIBROSIS ProFee" 50715 CDM 50715 HCPCS facility both 1773 1773 Gross Charge Type: NIHD_Hosp_Profee_Price 50780 URETERONEOCYSTOSTOMY; ANASTOMOSIS OF SINGLE URETER TO BLADDER ProFee 50780 CDM 975 RC 50780 HCPCS facility both 1942 1942 Gross Charge Type: NIHD_Hosp_Profee_Price 50780 URETERONEOCYSTOSTOMY; ANASTOMOSIS OF SINGLE URETER TO BLADDER ProFee 50780 CDM 975 RC 50780 HCPCS facility both 1942 1942 Gross Charge Type: NIHD_Hosp_Profee_Price "50947 LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITH CYSTOSCOPY AND URETERAL STENT PLACEME ProFee" 50947 CDM 975 RC 50947 HCPCS facility both 2438 2438 Gross Charge Type: NIHD_Hosp_Profee_Price "50947 LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY WITH CYSTOSCOPY AND URETERAL STENT PLACEME ProFee" 50947 CDM 975 RC 50947 HCPCS facility both 2438 2438 Gross Charge Type: NIHD_Hosp_Profee_Price "50961 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTI ProFee" 50961 CDM 982 RC 50961 HCPCS facility both 559 559 Gross Charge Type: NIHD_Hosp_Profee_Price "50961 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTI ProFee" 50961 CDM 982 RC 50961 HCPCS facility both 559 559 Gross Charge Type: NIHD_Hosp_Profee_Price "51040 CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE ProFee" 51040 CDM 982 RC 51040 HCPCS facility both 514 514 Gross Charge Type: NIHD_Hosp_Profee_Price "51040 CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE ProFee" 51040 CDM 982 RC 51040 HCPCS facility both 514 514 Gross Charge Type: NIHD_Hosp_Profee_Price 51100 Drain Bladder By Needle TechFee 511001 CDM 450 RC facility both 941 941 Gross Charge Type: NIHD_Hosp_Profee_Price 51100 Drain Bladder By Needle TechFee 511001 CDM 450 RC facility both 941 941 Gross Charge Type: NIHD_Hosp_Profee_Price 51100 ASPIRATION OF BLADDER; BY NEEDLE ProFee 511002 CDM 982 RC 51100 HCPCS facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 51100 ASPIRATION OF BLADDER; BY NEEDLE ProFee 511002 CDM 982 RC 51100 HCPCS facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 51102 Aspiration of bladder; with insertion of suprapubic catheter 511021 CDM 521 RC 51102 HCPCS facility both 424 424 Gross Charge Type: NIHD_RHC_Price 51102 Aspiration of bladder; with insertion of suprapubic catheter 511021 CDM 521 RC 51102 HCPCS facility both 424 424 Gross Charge Type: NIHD_Clinic_Price 51102 Drain Bl w Cath Insertion TechFee 511022 CDM 450 RC facility both 2733 2733 Gross Charge Type: NIHD_Hosp_Profee_Price 51102 Drain Bl w Cath Insertion TechFee 511022 CDM 450 RC facility both 2733 2733 Gross Charge Type: NIHD_Hosp_Profee_Price 51102 DRAIN BL W/CATH INSERTION 511023 CDM 361 RC facility both 4031 4031 Gross Charge Type: NIHD_Hosp_Profee_Price 51102 DRAIN BL W/CATH INSERTION 511023 CDM 361 RC facility both 4031 4031 Gross Charge Type: NIHD_Hosp_Profee_Price 51102 ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER ProFee 511024 CDM 982 RC 51102 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price 51102 ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER ProFee 511024 CDM 982 RC 51102 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price Humeral Fracture Orthosis (Over-the-Shoulder) MD 5131202 CDM 274 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price Humeral Fracture Orthosis (Over-the-Shoulder) MD 5131202 CDM 274 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price "51500 EXCISION OF URACHAL CYST OR SINUS, WITH OR WITHOUT UMBILICAL HERNIA REPAIR ProFee" 51500 CDM 982 RC 51500 HCPCS facility both 1125 1125 Gross Charge Type: NIHD_Hosp_Profee_Price "51500 EXCISION OF URACHAL CYST OR SINUS, WITH OR WITHOUT UMBILICAL HERNIA REPAIR ProFee" 51500 CDM 982 RC 51500 HCPCS facility both 1125 1125 Gross Charge Type: NIHD_Hosp_Profee_Price "51550 CYSTECTOMY, PARTIAL; SIMPLE ProFee" 51550 CDM 982 RC 51550 HCPCS facility both 1691 1691 Gross Charge Type: NIHD_Hosp_Profee_Price "51550 CYSTECTOMY, PARTIAL; SIMPLE ProFee" 51550 CDM 982 RC 51550 HCPCS facility both 1691 1691 Gross Charge Type: NIHD_Hosp_Profee_Price 51700 OBS ONLY BLDR IRRIGATION SMPL LAVAGE &INSTLJ CHARGE 51700 CDM 761 RC facility both 639 639 Gross Charge Type: NIHD_Hosp_Profee_Price 51700 OBS ONLY BLDR IRRIGATION SMPL LAVAGE &INSTLJ CHARGE 51700 CDM 761 RC facility both 639 639 Gross Charge Type: NIHD_Hosp_Profee_Price "51700 Bladder irrigation, simple, lavage and/or instillation" 517001 CDM 521 RC 51700 HCPCS facility both 139 139 Gross Charge Type: NIHD_RHC_Price "51700 Bladder irrigation, simple, lavage and/or instillation" 517001 CDM 521 RC 51700 HCPCS facility both 140 140 Gross Charge Type: NIHD_Clinic_Price 51700 BLDR IRRIGATION SMPL LAVAGE &/INSTLJ TechFee 517002 CDM 450 RC facility both 639 639 Gross Charge Type: NIHD_Hosp_Profee_Price 51700 BLDR IRRIGATION SMPL LAVAGE &/INSTLJ TechFee 517002 CDM 450 RC facility both 639 639 Gross Charge Type: NIHD_Hosp_Profee_Price "51700 BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION ProFee" 517003 CDM 982 RC 51700 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "51700 BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION ProFee" 517003 CDM 982 RC 51700 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 51701 INSERT NON DWELLING BLADDER CATH-ER SERV 51701 CDM 361 RC 51701 HCPCS facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price 51701 INSERT NON DWELLING BLADDER CATH-ER SERV 51701 CDM 361 RC 51701 HCPCS facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price 51701 Insertion of non-indwelling bladder catheter 517011 CDM 521 RC 51701 HCPCS facility both 195 195 Gross Charge Type: NIHD_RHC_Price 51701 Insertion of non-indwelling bladder catheter 517011 CDM 521 RC 51701 HCPCS facility both 58 58 Gross Charge Type: NIHD_Clinic_Price 51701 INSJ NON-NDWELLG BLADDER CATHETER TechFee 517012 CDM 450 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price 51701 INSJ NON-NDWELLG BLADDER CATHETER TechFee 517012 CDM 450 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price 51701 NONINDWELLING BLADDER CATH CHARGE 517013 CDM 361 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price 51701 NONINDWELLING BLADDER CATH CHARGE 517013 CDM 361 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price "51701 INSERTION OF NON-INDWELLING BLADDER CATHETER (EG, STRAIGHT CATHETERIZATION FOR RESIDUA ProFee" 517014 CDM 982 RC 51701 HCPCS facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price "51701 INSERTION OF NON-INDWELLING BLADDER CATHETER (EG, STRAIGHT CATHETERIZATION FOR RESIDUA ProFee" 517014 CDM 982 RC 51701 HCPCS facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price Urinary Catheter Insertion 51702 CDM 720 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price Urinary Catheter Insertion 51702 CDM 720 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 51702 Insertion of temporary indwelling bladder catheter; simple 517021 CDM 521 RC 51702 HCPCS facility both 97 97 Gross Charge Type: NIHD_RHC_Price 51702 Insertion of temporary indwelling bladder catheter; simple 517021 CDM 521 RC 51702 HCPCS facility both 97 97 Gross Charge Type: NIHD_Clinic_Price 51702 INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE TechFee 517022 CDM 450 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 51702 INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE TechFee 517022 CDM 450 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 51702 INDWELLING TEMP BLADDER CATH CHARGE 517023 CDM 361 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 51702 INDWELLING TEMP BLADDER CATH CHARGE 517023 CDM 361 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "51702 INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY) ProFee" 517024 CDM 982 RC 51702 HCPCS facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price "51702 INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY) ProFee" 517024 CDM 982 RC 51702 HCPCS facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price 51702 BLADDER CATH (INDWELLING) CHARGE 517025 CDM 361 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 51702 BLADDER CATH (INDWELLING) CHARGE 517025 CDM 361 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 51703 OBS ONLY INSR TEMP BLDR CATH COMP CHARGE 51703 CDM 761 RC facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price 51703 OBS ONLY INSR TEMP BLDR CATH COMP CHARGE 51703 CDM 761 RC facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price 51703 Insertion of temporary indwelling bladder catheter; complicated 517031 CDM 521 RC 51703 HCPCS facility both 832 832 Gross Charge Type: NIHD_RHC_Price 51703 Insertion of temporary indwelling bladder catheter; complicated 517031 CDM 521 RC 51703 HCPCS facility both 832 832 Gross Charge Type: NIHD_Clinic_Price 51703 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED TechFee 517032 CDM 450 RC facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price 51703 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED TechFee 517032 CDM 450 RC facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price "51703 INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED (EG, ALTERED ANATOMY, ProFee" 517033 CDM 982 RC 51703 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price "51703 INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED (EG, ALTERED ANATOMY, ProFee" 517033 CDM 982 RC 51703 HCPCS facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price 51705 Change of cystostomy tube; simple 517051 CDM 521 RC 51705 HCPCS facility both 164 164 Gross Charge Type: NIHD_RHC_Price 51705 Change of cystostomy tube; simple 517051 CDM 521 RC 51705 HCPCS facility both 164 164 Gross Charge Type: NIHD_Clinic_Price 51705 Change Cystostomy Tube Charge 517052 CDM 761 RC facility both 910 910 Gross Charge Type: NIHD_Hosp_Profee_Price 51705 Change Cystostomy Tube Charge 517052 CDM 761 RC facility both 910 910 Gross Charge Type: NIHD_Hosp_Profee_Price 51705 CHANGE OF CYSTOSTOMY TUBE; SIMPLE ProFee 517053 CDM 982 RC 51705 HCPCS facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price 51705 CHANGE OF CYSTOSTOMY TUBE; SIMPLE ProFee 517053 CDM 982 RC 51705 HCPCS facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price 51705 CHANGE CYSTOSTOMY TUBE SIMPLE TechFee 517054 CDM 450 RC facility both 910 910 Gross Charge Type: NIHD_Hosp_Profee_Price 51705 CHANGE CYSTOSTOMY TUBE SIMPLE TechFee 517054 CDM 450 RC facility both 910 910 Gross Charge Type: NIHD_Hosp_Profee_Price 51710 CHANGE OF CYSTOSTOMY TUBE; COMPLICATED ProFee 51710 CDM 982 RC 51710 HCPCS facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price 51710 CHANGE OF CYSTOSTOMY TUBE; COMPLICATED ProFee 51710 CDM 982 RC 51710 HCPCS facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price 51720 BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT CHARGE 51720 CDM 761 RC facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price 51720 BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT CHARGE 51720 CDM 761 RC facility both 476 476 Gross Charge Type: NIHD_Hosp_Profee_Price 51736 Simple uroflowmetry (UFR) 51736 CDM 521 RC 51736 HCPCS facility both 21 21 Gross Charge Type: NIHD_RHC_Price 51736 Simple uroflowmetry (UFR) 51736 CDM 521 RC 51736 HCPCS facility both 21 21 Gross Charge Type: NIHD_Clinic_Price "51741 Complex uroflowmetry (eg, calibrated electronic equipment)" 51741 CDM 521 RC 51741 HCPCS facility both 22 22 Gross Charge Type: NIHD_RHC_Price "51741 Complex uroflowmetry (eg, calibrated electronic equipment)" 51741 CDM 521 RC 51741 HCPCS facility both 22 22 Gross Charge Type: NIHD_Clinic_Price "51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging" 517981 CDM 521 RC 51798 HCPCS facility both 25 25 Gross Charge Type: NIHD_RHC_Price "51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging" 517981 CDM 521 RC 51798 HCPCS facility both 25 25 Gross Charge Type: NIHD_Clinic_Price "51798 MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON- TechFee" 517982 CDM 450 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price "51798 MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON- TechFee" 517982 CDM 450 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 51798 BLADDER SCAN CHARGE 517983 CDM 400 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 51798 BLADDER SCAN CHARGE 517983 CDM 400 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 51798 BLADDER SCAN CHARGE 517984 CDM 400 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 51798 BLADDER SCAN CHARGE 517984 CDM 400 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price "51798 MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON- ProFee" 517985 CDM 982 RC 51798 HCPCS facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "51798 MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON- ProFee" 517985 CDM 982 RC 51798 HCPCS facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Bladder Scan US 517986 CDM 402 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price Bladder Scan US 517986 CDM 402 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price US Bladder Scan 517987 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price US Bladder Scan 517987 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price US Bladder Scan - Report 517988 CDM 972 RC 51798 HCPCS facility both 26 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price US Bladder Scan - Report 517988 CDM 972 RC 51798 HCPCS facility both 26 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price "51860 CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; SIMPLE ProFee" 51860 CDM 982 RC 51860 HCPCS facility both 1355 1355 Gross Charge Type: NIHD_Hosp_Profee_Price "51860 CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; SIMPLE ProFee" 51860 CDM 982 RC 51860 HCPCS facility both 1355 1355 Gross Charge Type: NIHD_Hosp_Profee_Price "51865 CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; COMPLICATED ProFee" 51865 CDM 51865 HCPCS facility both 1322 1322 Gross Charge Type: NIHD_Hosp_Profee_Price "51865 CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; COMPLICATED ProFee" 51865 CDM 51865 HCPCS facility both 1322 1322 Gross Charge Type: NIHD_Hosp_Profee_Price "51992 LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETI ProFee" 51992 CDM 982 RC 51992 HCPCS facility both 1660 1660 Gross Charge Type: NIHD_Hosp_Profee_Price "51992 LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETI ProFee" 51992 CDM 982 RC 51992 HCPCS facility both 1660 1660 Gross Charge Type: NIHD_Hosp_Profee_Price "51999 UNLISTED LAPAROSCOPY PROCEDURE, BLADDER ProFee" 51999 CDM 982 RC 51999 HCPCS facility both 4494 4494 Gross Charge Type: NIHD_Hosp_Profee_Price "51999 UNLISTED LAPAROSCOPY PROCEDURE, BLADDER ProFee" 51999 CDM 982 RC 51999 HCPCS facility both 4494 4494 Gross Charge Type: NIHD_Hosp_Profee_Price 52000 Cystourethroscopy (separate procedure) 520001 CDM 521 RC 52000 HCPCS facility both 776 776 Gross Charge Type: NIHD_Clinic_Price 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE) ProFee 520002 CDM 982 RC 52000 HCPCS facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE) ProFee 520002 CDM 982 RC 52000 HCPCS facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price 52001 Pro Fee Cystoscopy and clot irrigation 52001 CDM 982 RC 52001 HCPCS facility both 418 418 Gross Charge Type: NIHD_Hosp_Profee_Price 52001 Pro Fee Cystoscopy and clot irrigation 52001 CDM 982 RC 52001 HCPCS facility both 418 418 Gross Charge Type: NIHD_Hosp_Profee_Price "52005 CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLA ProFee" 52005 CDM 982 RC 52005 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "52005 CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLA ProFee" 52005 CDM 982 RC 52005 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "52010 CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT IRRIGATION, ProFee" 52010 CDM 982 RC 52010 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price "52010 CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT IRRIGATION, ProFee" 52010 CDM 982 RC 52010 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5x12mm Kreulock compression Screw 5212021 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5x12mm Kreulock compression Screw 5212021 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5x14mm Kreulock Compression screw 5212022 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5x14mm Kreulock Compression screw 5212022 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "52204 CYSTOURETHROSCOPY, WITH BIOPSY(S) ProFee" 52204 CDM 982 RC 52204 HCPCS facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price "52204 CYSTOURETHROSCOPY, WITH BIOPSY(S) ProFee" 52204 CDM 982 RC 52204 HCPCS facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price "52214 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF TRIGON ProFee" 52214 CDM 982 RC 52214 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "52214 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF TRIGON ProFee" 52214 CDM 982 RC 52214 HCPCS facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price "52234 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RE ProFee" 52234 CDM 982 RC 52234 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price "52234 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RE ProFee" 52234 CDM 982 RC 52234 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price "52235 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RE ProFee" 52235 CDM 982 RC 52235 HCPCS facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price "52235 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RE ProFee" 52235 CDM 982 RC 52235 HCPCS facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price "52240 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RE ProFee" 52240 CDM 982 RC 52240 HCPCS facility both 736 736 Gross Charge Type: NIHD_Hosp_Profee_Price "52240 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RE ProFee" 52240 CDM 982 RC 52240 HCPCS facility both 736 736 Gross Charge Type: NIHD_Hosp_Profee_Price "52275 CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE ProFee" 52275 CDM 982 RC 52275 HCPCS facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price "52275 CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE ProFee" 52275 CDM 982 RC 52275 HCPCS facility both 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price "52281 CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, ProFee" 52281 CDM 982 RC 52281 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "52281 CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, ProFee" 52281 CDM 982 RC 52281 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "52281 Cystourethroscopy w/ calib/dilation, w/wo meatotomy, w/wo injection procedure, Male/Female" 522811 CDM 521 RC 52281 HCPCS facility both 509 509 Gross Charge Type: NIHD_RHC_Price "52281 Cystourethroscopy w/ calib/dilation, w/wo meatotomy, w/wo injection procedure, Male/Female" 522811 CDM 521 RC 52281 HCPCS facility both 509 509 Gross Charge Type: NIHD_Clinic_Price 52285 Cystourethroscopy for treatment of the female urethral syndrome 522851 CDM 521 RC 52285 HCPCS facility both 579 579 Gross Charge Type: NIHD_RHC_Price 52285 Cystourethroscopy for treatment of the female urethral syndrome 522851 CDM 521 RC 52285 HCPCS facility both 579 579 Gross Charge Type: NIHD_Clinic_Price 52285 CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL OF THE ProFee 522852 CDM 982 RC 52285 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price 52285 CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL OF THE ProFee 522852 CDM 982 RC 52285 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "52287 - Cystourethroscopy, with injection(s) for chemodenervation of the bladder" 52287 CDM 521 RC 52287 HCPCS facility both 607 607 Gross Charge Type: NIHD_RHC_Price "52287 - Cystourethroscopy, with injection(s) for chemodenervation of the bladder" 52287 CDM 521 RC 52287 HCPCS facility both 607 607 Gross Charge Type: NIHD_Clinic_Price "52287 CYSTOURETHROSCOPY, WITH INJECTION(S) FOR CHEMODENERVATION OF THE BLADDER ProFee" 522871 CDM 982 RC 52287 HCPCS facility both 247 247 Gross Charge Type: NIHD_Hosp_Profee_Price "52287 CYSTOURETHROSCOPY, WITH INJECTION(S) FOR CHEMODENERVATION OF THE BLADDER ProFee" 522871 CDM 982 RC 52287 HCPCS facility both 247 247 Gross Charge Type: NIHD_Hosp_Profee_Price EPIEFFFECT 2 cm x 3 cm sheet 5230001 CDM 636 RC facility both 1178 1178 Gross Charge Type: NIHD_Hosp_Profee_Price EPIEFFFECT 2 cm x 3 cm sheet 5230001 CDM 636 RC facility both 1178 1178 Gross Charge Type: NIHD_Hosp_Profee_Price "52310 Cystourethroscopy, w/ removal of foreign body, calculus, or ureteral stent; simple" 523101 CDM 521 RC 52310 HCPCS facility both 520 520 Gross Charge Type: NIHD_RHC_Price "52310 Cystourethroscopy, w/ removal of foreign body, calculus, or ureteral stent; simple" 523101 CDM 521 RC 52310 HCPCS facility both 520 520 Gross Charge Type: NIHD_Clinic_Price "52310 CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URET ProFee" 523102 CDM 982 RC 52310 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "52310 CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URET ProFee" 523102 CDM 982 RC 52310 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 52310 CYSTOURETHROSCOPY W REMOVAL OF STONE 523103 CDM 450 RC facility both 3238 3238 Gross Charge Type: NIHD_Hosp_Profee_Price 52310 CYSTOURETHROSCOPY W REMOVAL OF STONE 523103 CDM 450 RC facility both 3238 3238 Gross Charge Type: NIHD_Hosp_Profee_Price 52317 LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL ProFee 52317 CDM 982 RC 52317 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price 52317 LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL ProFee 52317 CDM 982 RC 52317 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price 52318 LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL ProFee 52318 CDM 982 RC 52318 HCPCS facility both 830 830 Gross Charge Type: NIHD_Hosp_Profee_Price 52318 LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL ProFee 52318 CDM 982 RC 52318 HCPCS facility both 830 830 Gross Charge Type: NIHD_Hosp_Profee_Price "52332 CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE- ProFee" 52332 CDM 982 RC 52332 HCPCS facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price "52332 CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE- ProFee" 52332 CDM 982 RC 52332 HCPCS facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price "52341 CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ProFee" 52341 CDM 975 RC 52341 HCPCS facility both 500 500 Gross Charge Type: NIHD_Hosp_Profee_Price "52341 CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ProFee" 52341 CDM 975 RC 52341 HCPCS facility both 500 500 Gross Charge Type: NIHD_Hosp_Profee_Price "52351 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC ProFee" 52351 CDM 982 RC 52351 HCPCS facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price "52351 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC ProFee" 52351 CDM 982 RC 52351 HCPCS facility both 446 446 Gross Charge Type: NIHD_Hosp_Profee_Price "52352 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION O ProFee" 52352 CDM 982 RC 52352 HCPCS facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price "52352 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION O ProFee" 52352 CDM 982 RC 52352 HCPCS facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price "52353 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETERAL CAT ProFee" 52353 CDM 982 RC 52353 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "52353 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETERAL CAT ProFee" 52353 CDM 982 RC 52353 HCPCS facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price "52354 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGURATION ProFee" 52354 CDM 982 RC 52354 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "52354 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGURATION ProFee" 52354 CDM 982 RC 52354 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "52356 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY INCLUDING INS ProFee" 52356 CDM 982 RC 52356 HCPCS facility both 729 729 Gross Charge Type: NIHD_Hosp_Profee_Price "52356 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY INCLUDING INS ProFee" 52356 CDM 982 RC 52356 HCPCS facility both 729 729 Gross Charge Type: NIHD_Hosp_Profee_Price "52441 CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT; SING ProFee" 52441 CDM 982 RC 52441 HCPCS facility both 397 397 Gross Charge Type: NIHD_Hosp_Profee_Price "52441 CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT; SING ProFee" 52441 CDM 982 RC 52441 HCPCS facility both 397 397 Gross Charge Type: NIHD_Hosp_Profee_Price "52442 CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT; EACH ProFee" 52442 CDM 982 RC 52442 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price "52442 CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT; EACH ProFee" 52442 CDM 982 RC 52442 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price 52500 TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE) ProFee 52500 CDM 982 RC 52500 HCPCS facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price 52500 TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE) ProFee 52500 CDM 982 RC 52500 HCPCS facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price SHORT PNEUMATIC WALKER MEDIUM 5255002 CDM 274 RC L4360 HCPCS facility both 105 105 Gross Charge Type: NIHD_RHC_Price SHORT PNEUMATIC WALKER MEDIUM 5255002 CDM 274 RC L4360 HCPCS facility both 105 105 Gross Charge Type: NIHD_Clinic_Price SHORT PNEUMATIC WALKER MEDIUM 5255002 CDM 274 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price SHORT PNEUMATIC WALKER MEDIUM 5255002 CDM 274 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price SHORT PNEUMATIC WALKER LARGE 5255003 CDM 274 RC facility both 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price SHORT PNEUMATIC WALKER LARGE 5255003 CDM 274 RC facility both 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT STAXX FINGER SIZE 6 5255247 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price SPLINT STAXX FINGER SIZE 6 5255247 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price SPLINT STAXX FINGER SIZE 6 5255247 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT STAXX FINGER SIZE 6 5255247 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price TALL PNEUMATIC WALKER SMALL 5255511 CDM 274 RC L4360 HCPCS facility both 178 178 Gross Charge Type: NIHD_RHC_Price TALL PNEUMATIC WALKER SMALL 5255511 CDM 274 RC L4360 HCPCS facility both 178 178 Gross Charge Type: NIHD_Clinic_Price TALL PNEUMATIC WALKER SMALL 5255511 CDM 274 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price TALL PNEUMATIC WALKER SMALL 5255511 CDM 274 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price TALL PNEUMATIC WALKER MEDIUM 5255512 CDM 274 RC L4360 HCPCS facility both 178 178 Gross Charge Type: NIHD_RHC_Price TALL PNEUMATIC WALKER MEDIUM 5255512 CDM 274 RC L4360 HCPCS facility both 178 178 Gross Charge Type: NIHD_Clinic_Price TALL PNEUMATIC WALKER MEDIUM 5255512 CDM 274 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price TALL PNEUMATIC WALKER MEDIUM 5255512 CDM 274 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price TALL PNEUMATIC WALKER LARGE 5255513 CDM 274 RC L4360 HCPCS facility both 178 178 Gross Charge Type: NIHD_RHC_Price TALL PNEUMATIC WALKER LARGE 5255513 CDM 274 RC L4360 HCPCS facility both 178 178 Gross Charge Type: NIHD_Clinic_Price TALL PNEUMATIC WALKER LARGE 5255513 CDM 274 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price TALL PNEUMATIC WALKER LARGE 5255513 CDM 274 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price TALL PNEUMATIC WALKER XTRA LARGE 5255514 CDM 274 RC L4360 HCPCS facility both 178 178 Gross Charge Type: NIHD_RHC_Price TALL PNEUMATIC WALKER XTRA LARGE 5255514 CDM 274 RC L4360 HCPCS facility both 178 178 Gross Charge Type: NIHD_Clinic_Price TALL PNEUMATIC WALKER XTRA LARGE 5255514 CDM 274 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price TALL PNEUMATIC WALKER XTRA LARGE 5255514 CDM 274 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price STAXX FINGER SPLINT SIZE 5 5255745 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price STAXX FINGER SPLINT SIZE 5 5255745 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price STAXX FINGER SPLINT SIZE 5 5255745 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price STAXX FINGER SPLINT SIZE 5 5255745 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price STAXX FINGER SPLINT SIZE 7 5255792 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price STAXX FINGER SPLINT SIZE 7 5255792 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price STAXX FINGER SPLINT SIZE 7 5255792 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price STAXX FINGER SPLINT SIZE 7 5255792 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price STAXX FINGER SPLINT SIZE 5.5 5255797 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price STAXX FINGER SPLINT SIZE 5.5 5255797 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price STAXX FINGER SPLINT SIZE 5.5 5255797 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price STAXX FINGER SPLINT SIZE 5.5 5255797 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "52601 TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIV ProFee" 52601 CDM 982 RC 52601 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "52601 TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIV ProFee" 52601 CDM 982 RC 52601 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price aminocaproic acid 250 mg/mL IV Sol [INYO] 5295 CDM J3490 HCPCS 00409-4346-73 NDC facility both 20 ML 330 330 Gross Charge Type: Pharmacy aminophylline 25 mg/mL IV Sol [INYO] 5297 CDM J0280 HCPCS 00409-5922-01 NDC facility both 20 ML 330 330 Gross Charge Type: Pharmacy Assert IQ 3+ICM 5300420 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price Assert IQ 3+ICM 5300420 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price ampicillin 500 mg Cap [INYO] 5307 CDM 00781-2145-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP alfentanil 0.5 mg/mL Inj Sol [INYO] 5308 CDM J0216 HCPCS 17478-0067-02 NDC facility both 2 ML 170 170 Gross Charge Type: Pharmacy ampicillin-sulbactam 3 g Inj [INYO] 5312 CDM J0295 HCPCS 44567-0211-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin-sulbactam 3 g Inj [INYO] 5312 CDM J0295 HCPCS 55150-0117-20 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin-sulbactam 3 g Inj [INYO] 5312 CDM J0295 HCPCS 44567-0150-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin-sulbactam 3 g Inj [INYO] 5312 CDM J0295 HCPCS 67457-0349-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin-sulbactam 3 g Inj [INYO] 5312 CDM J0295 HCPCS 71288-0006-30 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin-sulbactam 3 g Inj [INYO] 5312 CDM J0295 HCPCS 66794-0207-41 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin-sulbactam 3 g Inj [INYO] 5312 CDM J0295 HCPCS 00049-0014-83 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy sucralfate 1 g Tab [INYO] 5315 CDM 51079-0753-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sucralfate 1 g Tab [INYO] 5315 CDM 00093-2210-98 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sucralfate 1 g Tab [INYO] 5315 CDM 63739-0943-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ampicillin-sulbactam 1 g-0.5 g Inj [INYO] 5316 CDM J0295 HCPCS 44567-0210-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin-sulbactam 1 g-0.5 g Inj [INYO] 5316 CDM J0295 HCPCS 66794-0206-41 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin-sulbactam 1 g-0.5 g Inj [INYO] 5316 CDM J0295 HCPCS 00641-6116-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy hydrALAZINE 25 mg Tab [INYO] 5334 CDM 00904-6441-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrALAZINE 25 mg Tab 5334 CDM 63739-0327-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrALAZINE 20 mg/mL Sol [inyo] 5338 CDM J0360 HCPCS 00641-6231-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy hydrALAZINE 20 mg/mL Inj Sol [INYO] 5338 CDM J0360 HCPCS 00517-0901-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy hydrALAZINE 20 mg/mL Inj Sol [INYO] 5338 CDM J0360 HCPCS 63323-0614-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy triamcinolone Top 0.1% Oint [INYO] 5348 CDM 51672-1284-01 NDC facility both 1 EA 28.95 28.95 Gross Charge Type: Pharmacy | NDC EA = 15 APP triamcinolone topical 0.1% Oint [INYO] 5348 CDM 00168-0006-15 NDC facility both 1 EA 27.9 27.9 Gross Charge Type: Pharmacy | NDC EA = 15 APP triamcinolone Top 0.025% Crm [INYO] 5349 CDM 00168-0003-15 NDC facility both 1 EA 22.3 22.3 Gross Charge Type: Pharmacy | NDC EA = 15 APP EPIEFFECT 3 cm x 5 cm sheet 5350002 CDM 636 RC facility both 1178 1178 Gross Charge Type: NIHD_Hosp_Profee_Price EPIEFFECT 3 cm x 5 cm sheet 5350002 CDM 636 RC facility both 1178 1178 Gross Charge Type: NIHD_Hosp_Profee_Price triamcinolone Top 0.5% Crm [INYO] 5351 CDM 00168-0002-15 NDC facility both 1 EA 55.5 55.5 Gross Charge Type: Pharmacy | NDC EA = 15 APP triamcinolone topical 0.025% Cream 80 g [INYO] 5353 CDM 00168-0003-80 NDC facility both 1 EA 55.75 55.75 Gross Charge Type: Pharmacy | NDC EA = 80 APP triamcinolone Top 0.025% Oint [INYO] 5354 CDM 00168-0005-80 NDC facility both 1 EA 55.75 55.75 Gross Charge Type: Pharmacy | NDC EA = 80 APP aspirin 600 mg Supp [INYO] 5361 CDM 00574-7036-12 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP ascorbic acid 500 mg Tab [INYO] 5362 CDM 00904-0523-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 325 mg Tab 5369 CDM 00536-1054-29 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 325 mg Tab [INYO] 5369 CDM 66553-0001-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 325 mg Tab [INYO] 5369 CDM 57896-0901-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB atropine ophthalmic 1% Sol [inyo] 5379 CDM 60219-1749-03 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS atropine Ophth 1% Sol [INYO] 5379 CDM 00065-0303-55 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS "dextran, low molecular weight 10%-D5W IV Sol 500 mL [INYO]" 5386 CDM J7100 HCPCS 00409-7418-03 NDC facility both 500 ML 318.36 318.36 Gross Charge Type: Pharmacy traZODone 50 mg Tab [INYO] 5389 CDM 00904-6868-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB traZODone 50 mg Tab [INYO] 5389 CDM 60687-0443-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB traZODone 50 mg Tab [INYO] 5389 CDM 00904-6554-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB miconazole Top 2% Crm [INYO] 5390 CDM 00472-0735-14 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 14 APP sulfaSALAzine 500 mg Tab [INYO] 5391 CDM 59762-5000-05 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sulfaSALAzine 500 mg Tab [INYO] 5391 CDM 59762-5000-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "bacitracin 50,000 units IM Inj [INYO]" 5394 CDM 00009-0233-44 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy "bacitracin 50,000 units IM Inj [INYO]" 5394 CDM 70594-0026-02 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy desmopressin 4 mcg/mL IV Sol [INYO] 5403 CDM J2597 HCPCS 43598-0931-09 NDC facility both 1 ML 330 330 Gross Charge Type: Pharmacy desmopressin 4 mcg/mL IV Sol [INYO] 5403 CDM J2597 HCPCS 69918-0899-10 NDC facility both 1 ML 330 330 Gross Charge Type: Pharmacy "54055 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERP ProFee" 54055 CDM 982 RC 54055 HCPCS facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price "54055 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERP ProFee" 54055 CDM 982 RC 54055 HCPCS facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price "54056 Destruction of lesion(s), penis, simple; cryosurgery" 54056 CDM 521 RC 54056 HCPCS facility both 223 223 Gross Charge Type: NIHD_RHC_Price "54056 Destruction of lesion(s), penis, simple; cryosurgery" 54056 CDM 521 RC 54056 HCPCS facility both 223 223 Gross Charge Type: NIHD_Clinic_Price simvastatin 20 mg Tab [INYO] 5406 CDM 63739-0572-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB simvastatin 20 mg Tab [INYO] 5406 CDM 16729-0005-15 NDC facility both 1 EA 29.41 29.41 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ROOM/BED: Pediatrics 5412974 CDM 123 RC facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Pediatrics 5412974 CDM 123 RC facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price diphenhydrAMINE 25 mg Tab [INYO] 5415 CDM Q0163 HCPCS 68094-0018-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB diphenhydrAMINE 25 mg Tab [INYO] 5415 CDM Q0163 HCPCS 00904-5551-59 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "54150 Circumcision, using clamp or other device with regional dorsal penile or ring block" 541501 CDM 521 RC 54150 HCPCS facility both 462 462 Gross Charge Type: NIHD_RHC_Price "54150 Circumcision, using clamp or other device with regional dorsal penile or ring block" 541501 CDM 521 RC 54150 HCPCS facility both 462 462 Gross Charge Type: NIHD_Clinic_Price 54150 Excision Procedures on the Penis 541502 CDM 982 RC 54150 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 54150 Excision Procedures on the Penis 541502 CDM 982 RC 54150 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Circumcision 541503 CDM 723 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price Circumcision 541503 CDM 723 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price Circumcision of newborn- self pay 541504 CDM 521 RC 54150 HCPCS facility both 462 462 Gross Charge Type: NIHD_RHC_Price Circumcision of newborn- self pay 541504 CDM 521 RC 54150 HCPCS facility both 462 462 Gross Charge Type: NIHD_Clinic_Price "54160 Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of" 54160 CDM 521 RC 54160 HCPCS facility both 411 411 Gross Charge Type: NIHD_RHC_Price "54160 Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of" 54160 CDM 521 RC 54160 HCPCS facility both 413 413 Gross Charge Type: NIHD_Clinic_Price "54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 2 ProFee" 54161 CDM 982 RC 54161 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 2 ProFee" 54161 CDM 982 RC 54161 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 54162 LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS ProFee 54162 CDM 982 RC 54162 HCPCS facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price 54162 LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS ProFee 54162 CDM 982 RC 54162 HCPCS facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price 54163 REPAIR INCOMPLETE CIRCUMCISION ProFee 54163 CDM 982 RC 54163 HCPCS facility both 388 388 Gross Charge Type: NIHD_Hosp_Profee_Price 54163 REPAIR INCOMPLETE CIRCUMCISION ProFee 54163 CDM 982 RC 54163 HCPCS facility both 388 388 Gross Charge Type: NIHD_Hosp_Profee_Price 54164 FRENULOTOMY OF PENIS ProFee 54164 CDM 982 RC 54164 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price 54164 FRENULOTOMY OF PENIS ProFee 54164 CDM 982 RC 54164 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price probenecid 500 mg Tab [INYO] 5421 CDM 00378-0156-01 NDC facility both 1 EA 6.87 6.87 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM ProFee 54220 CDM 982 RC 54220 HCPCS facility both 399 399 Gross Charge Type: NIHD_Hosp_Profee_Price 54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM ProFee 54220 CDM 982 RC 54220 HCPCS facility both 399 399 Gross Charge Type: NIHD_Hosp_Profee_Price 54220 Irrigation of corpora cavernosa for priapism 542201 CDM 450 RC facility both 800 800 Gross Charge Type: NIHD_Hosp_Profee_Price 54220 Irrigation of corpora cavernosa for priapism 542201 CDM 450 RC facility both 800 800 Gross Charge Type: NIHD_Hosp_Profee_Price dicyclomine 20 mg Tab [INYO] 5424 CDM 60687-0380-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dicyclomine 20 mg Tab [INYO] 5424 CDM 00904-6988-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dicyclomine 20 mg Tab [INYO] 5424 CDM 51079-0119-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Super Sheath CBDE (Introducer) 5429610 CDM 272 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price Super Sheath CBDE (Introducer) 5429610 CDM 272 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price SpyGlass Discover Guidewire 5429710 CDM 272 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price SpyGlass Discover Guidewire 5429710 CDM 272 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price Imager II IOC Catheter 5429810 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price Imager II IOC Catheter 5429810 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price SpyGlass Discover Retrieval Basket 5429900 CDM 272 RC facility both 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price SpyGlass Discover Retrieval Basket 5429900 CDM 272 RC facility both 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price SpyGlass Discover Baloon 6mm x 4cm 5430000 CDM 272 RC facility both 498 498 Gross Charge Type: NIHD_Hosp_Profee_Price SpyGlass Discover Baloon 6mm x 4cm 5430000 CDM 272 RC facility both 498 498 Gross Charge Type: NIHD_Hosp_Profee_Price 54450 FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING ProFee 54450 CDM 54450 HCPCS facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 54450 FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING ProFee 54450 CDM 54450 HCPCS facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 54450 FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING TechFee 544501 CDM 450 RC facility both 682 682 Gross Charge Type: NIHD_Hosp_Profee_Price 54450 FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING TechFee 544501 CDM 450 RC facility both 682 682 Gross Charge Type: NIHD_Hosp_Profee_Price bisacodyl 5 mg Oral EC Tab [INYO] 5448 CDM 00904-6407-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "54520 ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SC ProFee" 54520 CDM 982 RC 54520 HCPCS facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price "54520 ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SC ProFee" 54520 CDM 982 RC 54520 HCPCS facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price "54530 ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH ProFee" 54530 CDM 982 RC 54530 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "54530 ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH ProFee" 54530 CDM 982 RC 54530 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "54600 REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TE ProFee" 54600 CDM 982 RC 54600 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price "54600 REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TE ProFee" 54600 CDM 982 RC 54600 HCPCS facility both 837 837 Gross Charge Type: NIHD_Hosp_Profee_Price "54640 ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR ProFee" 54640 CDM 982 RC 54640 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "54640 ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR ProFee" 54640 CDM 982 RC 54640 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price Aotolith Touch EHL Probe 5466200 CDM 272 RC facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price Aotolith Touch EHL Probe 5466200 CDM 272 RC facility both 1124 1124 Gross Charge Type: NIHD_Hosp_Profee_Price SpyGlass Discover Digital Catheter 5467800 CDM 272 RC facility both 7202 7202 Gross Charge Type: NIHD_Hosp_Profee_Price SpyGlass Discover Digital Catheter 5467800 CDM 272 RC facility both 7202 7202 Gross Charge Type: NIHD_Hosp_Profee_Price "54700 INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMAT ProFee" 54700 CDM 982 RC 54700 HCPCS facility both 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price "54700 INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMAT ProFee" 54700 CDM 982 RC 54700 HCPCS facility both 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price 54700 ED INCISION AND DRAINAGE EPIDIDYMIS TSTIS&/SCROTAL SPACE TechFee 547001 CDM 450 RC facility both 5526 5526 Gross Charge Type: NIHD_Hosp_Profee_Price 54700 ED INCISION AND DRAINAGE EPIDIDYMIS TSTIS&/SCROTAL SPACE TechFee 547001 CDM 450 RC facility both 5526 5526 Gross Charge Type: NIHD_Hosp_Profee_Price fluorouracil 500 mg/10 mL IV Sol [INYO] 5471 CDM J9190 HCPCS 70700-0186-23 NDC facility both 10 ML 225 225 Gross Charge Type: Pharmacy fluorouracil 500 mg/10 mL IV Sol [INYO] 5471 CDM J9190 HCPCS 63323-0117-10 NDC facility both 10 ML 252 252 Gross Charge Type: Pharmacy morphine 1 mg/mL preservative-free Inj Sol [INYO] 5474 CDM J2274 HCPCS 00641-6019-10 NDC facility both 10 ML 278.01 278.01 Gross Charge Type: Pharmacy norEPINEPHrine 1 mg/mL IV Sol [INYO] 5476 CDM 70121-1576-07 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy norepinephrine 1 mg/mL Sol [inyo] 5476 CDM 47335-0615-44 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy norEPINEPHrine 1 mg/mL IV Sol [INYO] 5476 CDM 00781-3755-95 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy norEPINEPHrine 1 mg/mL IV Sol [INYO] 5476 CDM 00409-3375-04 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy "54840 EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY ProFee" 54840 CDM 54840 HCPCS facility both 487 487 Gross Charge Type: NIHD_Hosp_Profee_Price "54840 EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY ProFee" 54840 CDM 54840 HCPCS facility both 487 487 Gross Charge Type: NIHD_Hosp_Profee_Price 54860 EPIDIDYMECTOMY; UNILATERAL ProFee 54860 CDM 982 RC 54860 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 54860 EPIDIDYMECTOMY; UNILATERAL ProFee 54860 CDM 982 RC 54860 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price calamine-zinc oxide topical 8%-8% Lot [INYO] 5487 CDM 00395-0413-96 NDC facility both 1 EA 20.95 20.95 Gross Charge Type: Pharmacy | NDC EA = 177 APP morphine 15 mg/8 to 12 hr UD [INYO] 5488 CDM 00406-8315-62 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB morphine 30 mg/8 to 12 hr UD [INYO] 5489 CDM 00406-8330-62 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB morphine 30 mg/8 to 12 hr Tab [INYO] 5489 CDM 00904-6558-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB calcium gluconate 1000 mg/10 mL Inj Sol [INYO] 5490 CDM J0610 HCPCS 63323-0360-19 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy calcium gluconate 1000 mg/10 mL Inj Sol [INYO] 5490 CDM J0610 HCPCS 63323-0311-19 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy CARBOplatin 50 mg/5mL Sol [INYO] 5491 CDM J9045 HCPCS 61703-0339-18 NDC facility both 5 ML 225 225 Gross Charge Type: Pharmacy 55040 EXCISION OF HYDROCELE; UNILATERAL ProFee 55040 CDM 982 RC 55040 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 55040 EXCISION OF HYDROCELE; UNILATERAL ProFee 55040 CDM 982 RC 55040 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 55041 EXCISION OF HYDROCELE; BILATERAL ProFee 55041 CDM 982 RC 55041 HCPCS facility both 1555 1555 Gross Charge Type: NIHD_Hosp_Profee_Price 55041 EXCISION OF HYDROCELE; BILATERAL ProFee 55041 CDM 982 RC 55041 HCPCS facility both 1555 1555 Gross Charge Type: NIHD_Hosp_Profee_Price 55100 Drainage of scrotal wall abscess TechFee 55100 CDM 450 RC facility both 2941 2941 Gross Charge Type: NIHD_Hosp_Profee_Price 55100 Drainage of scrotal wall abscess TechFee 55100 CDM 450 RC facility both 2941 2941 Gross Charge Type: NIHD_Hosp_Profee_Price 55100 ED Pro Fee Drainage of Scrotal Wall Abscess 551001 CDM 55100 HCPCS facility both 251 251 Gross Charge Type: NIHD_Hosp_Profee_Price 55100 ED Pro Fee Drainage of Scrotal Wall Abscess 551001 CDM 55100 HCPCS facility both 251 251 Gross Charge Type: NIHD_Hosp_Profee_Price 55100 Drainage of scrotal wall abscess 551002 CDM 521 RC 55100 HCPCS facility both 251 251 Gross Charge Type: NIHD_RHC_Price 55100 Drainage of scrotal wall abscess 551002 CDM 521 RC 55100 HCPCS facility both 251 251 Gross Charge Type: NIHD_Clinic_Price "55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)" 55250 CDM 521 RC 55250 HCPCS facility both 1330 1330 Gross Charge Type: NIHD_RHC_Price "55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)" 55250 CDM 521 RC 55250 HCPCS facility both 1330 1330 Gross Charge Type: NIHD_Clinic_Price chloramphenicol 1 g IV Inj [INYO] 5533 CDM J0720 HCPCS 63323-0011-15 NDC facility both 1 EA 373.63 373.63 Gross Charge Type: Pharmacy cefuroxime 250 mg Tab [INYO] 5542 CDM 60687-0272-94 NDC facility both 1 EA 24.75 24.75 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cefuroxime 250 mg Tab [INYO] 5542 CDM 65862-0699-20 NDC facility both 1 EA 26.39 26.39 Gross Charge Type: Pharmacy | NDC EA = 1 TAB medroxyPROGESTERone 150 mg/mL IM Susp [INYO] 5545 CDM J1050 HCPCS 66993-0370-83 NDC facility both 1 ML 782.8 782.8 Gross Charge Type: Pharmacy medroxyPROGESTERone 150 mg/mL IM Susp [INYO] 5545 CDM J1050 HCPCS 59762-4537-01 NDC facility both 1 ML 782.8 782.8 Gross Charge Type: Pharmacy magnesium citrate Oral Liq 296 mL [INYO] 5549 CDM 71399-0051-01 NDC facility both 296 ML 21.29 21.29 Gross Charge Type: Pharmacy magnesium citrate 1.745 g/30 mL Liq [INYO] 5549 CDM 00904-7418-44 NDC facility both 296 ML 21.19 21.19 Gross Charge Type: Pharmacy magnesium citrate Oral Liq 296 mL [INYO] 5549 CDM 71399-7889-01 NDC facility both 296 ML 21.29 21.29 Gross Charge Type: Pharmacy magnesium citrate Oral Liq 296 mL [INYO] 5549 CDM 70000-0576-01 NDC facility both 296 ML 11.93 11.93 Gross Charge Type: Pharmacy TIBIAL BEARING INSERT-PS SZ 4 11MM 5550298 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 4 11MM 5550298 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price clindamycin 150 mg Cap [INYO] 5551 CDM 00904-5959-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP clindamycin 300 mg/2mL Sol [INYO] 5552 CDM J0736 HCPCS 00009-0870-26 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy 55520 EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE) ProFee 55520 CDM 982 RC 55520 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price 55520 EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE) ProFee 55520 CDM 982 RC 55520 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "55559 UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD ProFee" 55559 CDM 982 RC 55559 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price "55559 UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD ProFee" 55559 CDM 982 RC 55559 HCPCS facility both 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price docusate sodium 250 mg Oral Cap [INYO] 5559 CDM 48433-0101-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP docusate sodium 250 mg Oral Cap [INYO] 5559 CDM 68094-0025-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP docusate sodium 250 mg Oral Cap [INYO] 5559 CDM 50268-0268-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP docusate sodium 250 mg Oral Cap [INYO] 5559 CDM 00904-6999-60 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP docusate sodium 250 mg Oral Cap [INYO] 5559 CDM 54629-0601-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP docusate 10 mg/mL Liq [INYO] 5560 CDM 48433-0220-40 NDC facility both 10 ML 12.05 12.05 Gross Charge Type: Pharmacy docusate 10 mg/mL Liq [INYO] 5560 CDM 50383-0349-11 NDC facility both 10 ML 6 6 Gross Charge Type: Pharmacy docusate sodium 100 mg/10 mL Oral Liq [INYO] 5560 CDM 50383-0771-11 NDC facility both 10 ML 6 6 Gross Charge Type: Pharmacy docusate sodium 100 mg/10 mL Oral Liq [INYO] 5560 CDM 00536-0590-85 NDC facility both 10 ML 6 6 Gross Charge Type: Pharmacy colchicine 0.6 mg Tab [INYO] 5562 CDM 00904-7120-04 NDC facility both 1 EA 34.54 34.54 Gross Charge Type: Pharmacy | NDC EA = 1 TAB colchicine 0.6 mg Tab [INYO] 5562 CDM 42292-0054-03 NDC facility both 1 EA 55.75 55.75 Gross Charge Type: Pharmacy | NDC EA = 1 TAB colchicine 0.6 mg Tab [inyo] 5562 CDM 60687-0389-21 NDC facility both 1 EA 55.75 55.75 Gross Charge Type: Pharmacy | NDC EA = 1 TAB colchicine 0.6 mg Tab [INYO] 5562 CDM 64764-0119-07 NDC facility both 1 EA 51.77 51.77 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [INYO]" 5565 CDM 50632-0010-01 NDC facility both 1 EA 2980.14 2980.14 Gross Charge Type: Pharmacy "rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [INYO]" 5565 CDM 63851-0501-02 NDC facility both 1 EA 1983.76 1983.76 Gross Charge Type: Pharmacy "rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [INYO]" 5565 CDM 58160-0964-12 NDC facility both 1 EA 2499.18 2499.18 Gross Charge Type: Pharmacy prochlorperazine 10 mg/2 mL Inj Sol [INYO] 5569 CDM J0780 HCPCS 00641-6135-25 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy prochlorperazine 10 mg/2 mL Inj Sol [INYO] 5569 CDM J0780 HCPCS 67457-0640-99 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy prochlorperazine 10 mg/2 mL Inj Sol [INYO] 5569 CDM J0780 HCPCS 72266-0204-10 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy prochlorperazine 10 mg/2 mL Inj Sol [INYO] 5569 CDM J0780 HCPCS 23155-0294-42 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy prochlorperazine 10 mg/2 mL Inj Sol [INYO] 5569 CDM J0780 HCPCS 70121-1580-07 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy prochlorperazine 10 mg/2 mL Inj Sol [INYO] 5569 CDM J0780 HCPCS 70860-0778-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy prochlorperazine 5 mg Tab [INYO] 5570 CDM Q0164 HCPCS 50268-0684-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB prochlorperazine 5 mg Tab [inyo] 5570 CDM Q0164 HCPCS 00904-7381-06 NDC facility both 1 EA 9.13 9.13 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "55700 Biopsy, prostate; needle or punch, single or multiple, any approach" 55700 CDM 521 RC 55700 HCPCS facility both 834 834 Gross Charge Type: NIHD_RHC_Price "55700 Biopsy, prostate; needle or punch, single or multiple, any approach" 55700 CDM 521 RC 55700 HCPCS facility both 834 834 Gross Charge Type: NIHD_Clinic_Price "55700 BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH ProFee" 557001 CDM 982 RC 55700 HCPCS facility both 191 191 Gross Charge Type: NIHD_Hosp_Profee_Price "55700 BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH ProFee" 557001 CDM 982 RC 55700 HCPCS facility both 191 191 Gross Charge Type: NIHD_Hosp_Profee_Price NIFEdipine 10 mg Cap [INYO] 5579 CDM 00904-7229-61 NDC facility both 1 EA 7.75 7.75 Gross Charge Type: Pharmacy | NDC EA = 1 CAP NIFEdipine 10 mg Cap [INYO] 5579 CDM 60687-0425-01 NDC facility both 1 EA 7.52 7.52 Gross Charge Type: Pharmacy | NDC EA = 1 CAP NIFEdipine 10 mg Cap [INYO] 5579 CDM 23155-0194-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP NIFEdipine 10 mg Cap [INYO] 5579 CDM 50268-0600-15 NDC facility both 1 EA 11.78 11.78 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "55821 PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEATOTOMY, URET ProFee" 55821 CDM 982 RC 55821 HCPCS facility both 1540 1540 Gross Charge Type: NIHD_Hosp_Profee_Price "55821 PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEATOTOMY, URET ProFee" 55821 CDM 982 RC 55821 HCPCS facility both 1540 1540 Gross Charge Type: NIHD_Hosp_Profee_Price "55831 PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEATOTOMY, URET ProFee" 55831 CDM 982 RC 55831 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price "55831 PROSTATECTOMY (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEATOTOMY, URET ProFee" 55831 CDM 982 RC 55831 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price "55845 PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH BILATERAL PELVI ProFee" 55845 CDM 982 RC 55845 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "55845 PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING; WITH BILATERAL PELVI ProFee" 55845 CDM 982 RC 55845 HCPCS facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price "55866 LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCL ProFee" 55866 CDM 982 RC 55866 HCPCS facility both 2538 2538 Gross Charge Type: NIHD_Hosp_Profee_Price "55866 LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCL ProFee" 55866 CDM 982 RC 55866 HCPCS facility both 2538 2538 Gross Charge Type: NIHD_Hosp_Profee_Price "55899 UNLISTED PROCEDURE, MALE GENITAL SYSTEM ProFee" 55899 CDM 982 RC 55899 HCPCS facility both 506 506 Gross Charge Type: NIHD_Hosp_Profee_Price "55899 UNLISTED PROCEDURE, MALE GENITAL SYSTEM ProFee" 55899 CDM 982 RC 55899 HCPCS facility both 506 506 Gross Charge Type: NIHD_Hosp_Profee_Price hydrocortisone/neomycin/polymyxin B Otic Sol [INYO] 5590 CDM 24208-0631-10 NDC facility both 1 EA 402.72 402.72 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS cosyntropin 0.25 mg Inj [INYO] 5600 CDM J0834 HCPCS 00548-5900-00 NDC facility both 1 EA 1023.17 1023.17 Gross Charge Type: Pharmacy cosyntropin 0.25 mg Inj [INYO] 5600 CDM J0834 HCPCS 00781-3440-95 NDC facility both 1 EA 769.92 769.92 Gross Charge Type: Pharmacy cyclopentolate Ophth 1% Sol [INYO] 5605 CDM 61314-0396-01 NDC facility both 1 EA 252 252 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS cyclopentolate Ophth 1% Sol [INYO] 5605 CDM 00065-0396-05 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS lisinopril 10 mg Tab [INYO] 5608 CDM 00904-6798-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lisinopril 10 mg Tab [INYO] 5608 CDM 00904-6485-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB SCREW CORT 3.5X14MM 56346 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X14MM 56346 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price 56405 Incision and drainage of vulva or perineal abscess 564051 CDM 521 RC 56405 HCPCS facility both 573 573 Gross Charge Type: NIHD_RHC_Price 56405 Incision and drainage of vulva or perineal abscess 564051 CDM 521 RC 56405 HCPCS facility both 219 219 Gross Charge Type: NIHD_Clinic_Price 56405 I&D VULVA/PERINEAL ABSCESS TechFee 564052 CDM 450 RC facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price 56405 I&D VULVA/PERINEAL ABSCESS TechFee 564052 CDM 450 RC facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price I&D Vulva/Perineum Abscess Charge 564053 CDM 761 RC facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price I&D Vulva/Perineum Abscess Charge 564053 CDM 761 RC facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price 56405 INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS ProFee 564054 CDM 982 RC 56405 HCPCS facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price 56405 INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS ProFee 564054 CDM 982 RC 56405 HCPCS facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price 56420 Incision and drainage of Bartholin's gland abscess 564201 CDM 521 RC 56420 HCPCS facility both 255 255 Gross Charge Type: NIHD_RHC_Price 56420 I&D OF BARTHOLINS GLAND ABSCESS TechFee 564202 CDM 450 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 56420 I&D OF BARTHOLINS GLAND ABSCESS TechFee 564202 CDM 450 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 56420 I&D BARTHOLINS GLANDS ABSC CHARGE 564203 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 56420 I&D BARTHOLINS GLANDS ABSC CHARGE 564203 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 56420 INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS ProFee 564204 CDM 982 RC 56420 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 56420 INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS ProFee 564204 CDM 982 RC 56420 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 56440 MARSUPIALIZATION OF BARTH CYST CHARGE 564401 CDM 761 RC facility both 4695 4695 Gross Charge Type: NIHD_Hosp_Profee_Price 56440 MARSUPIALIZATION OF BARTH CYST CHARGE 564401 CDM 761 RC facility both 4695 4695 Gross Charge Type: NIHD_Hosp_Profee_Price 56440 MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST ProFee 564402 CDM 982 RC 56440 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 56440 MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST ProFee 564402 CDM 982 RC 56440 HCPCS facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price "56501 Destruction of lesion vulva, simple" 56501 CDM 521 RC 56501 HCPCS facility both 610 610 Gross Charge Type: NIHD_RHC_Price "56501 Destruction of lesion vulva, simple" 56501 CDM 521 RC 56501 HCPCS facility both 610 610 Gross Charge Type: NIHD_Clinic_Price "KNAPP HINGED KNEE ORTHOSIS LG 12""" 5656540 CDM 274 RC L1820 HCPCS facility both 285 285 Gross Charge Type: NIHD_RHC_Price "KNAPP HINGED KNEE ORTHOSIS LG 12""" 5656540 CDM 274 RC L1820 HCPCS facility both 285 285 Gross Charge Type: NIHD_Clinic_Price "KNAPP HINGED KNEE ORTHOSIS LG 12""" 5656540 CDM 274 RC facility both 285 285 Gross Charge Type: NIHD_Hosp_Profee_Price "KNAPP HINGED KNEE ORTHOSIS LG 12""" 5656540 CDM 274 RC facility both 285 285 Gross Charge Type: NIHD_Hosp_Profee_Price 56605 Biopsy of vulva or perineum; 1 lesion 566051 CDM 521 RC 56605 HCPCS facility both 126 126 Gross Charge Type: NIHD_RHC_Price 56605 BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION ProFee 566052 CDM 982 RC 56605 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price 56605 BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION ProFee 566052 CDM 982 RC 56605 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price 56606 Biopsy of vulva or perineum; each separate additional lesion 566061 CDM 521 RC 56606 HCPCS facility both 227 227 Gross Charge Type: NIHD_RHC_Price 56606 BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION (LIS ProFee 566062 CDM 982 RC 56606 HCPCS facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price 56606 BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION (LIS ProFee 566062 CDM 982 RC 56606 HCPCS facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price 56620 VULVECTOMY (LABIOPLASTY)- SIMPLE/PARTIAL ProFee 56620 CDM 982 RC 56620 HCPCS facility both 980 980 Gross Charge Type: NIHD_Hosp_Profee_Price 56620 VULVECTOMY (LABIOPLASTY)- SIMPLE/PARTIAL ProFee 56620 CDM 982 RC 56620 HCPCS facility both 980 980 Gross Charge Type: NIHD_Hosp_Profee_Price 56700 Partial hymenectomy or revision of hymenal ring 56700 CDM 521 RC 56700 HCPCS facility both 335 335 Gross Charge Type: NIHD_RHC_Price 56700 Partial hymenectomy or revision of hymenal ring 56700 CDM 521 RC 56700 HCPCS facility both 335 335 Gross Charge Type: NIHD_Clinic_Price 56740 EXCISION OF BARTHOLIN'S GLAND OR CYST ProFee 56740 CDM 982 RC 56740 HCPCS facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price 56740 EXCISION OF BARTHOLIN'S GLAND OR CYST ProFee 56740 CDM 982 RC 56740 HCPCS facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price methylPREDNISolone acetate 40 mg/mL Inj [INYO] 5678 CDM J1010 HCPCS 70121-1573-05 NDC facility both 5 ML 462.5 462.5 Gross Charge Type: Pharmacy methylPREDNISolone acetate 40 mg/mL Inj [INYO] 5678 CDM J1010 HCPCS 00009-0280-02 NDC facility both 5 ML 440.08 440.08 Gross Charge Type: Pharmacy methylPREDNISolone acetate 40 mg/mL Inj [INYO] 5678 CDM J1010 HCPCS 00009-3073-03 NDC facility both 5 ML 509.98 509.98 Gross Charge Type: Pharmacy "56810 Perineoplasty, repair of perineum, nonobstetrical" 568101 CDM 521 RC 56810 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_RHC_Price "56810 PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE) ProFee" 568102 CDM 982 RC 56810 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "56810 PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE) ProFee" 568102 CDM 982 RC 56810 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price benzocaine-menthol topical 20%-0.5% Spr [INYO] 5688 CDM 16864-0680-01 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 78 SPRAYS benzocaine-menthol topical 20%-0.5% Spr [INYO] 5688 CDM 16864-0680-03 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 78 SPRAYS PRESSURE RATED CVC KIT 5698741 CDM facility both 354 354 Gross Charge Type: NIHD_Hosp_Profee_Price PRESSURE RATED CVC KIT 5698741 CDM facility both 354 354 Gross Charge Type: NIHD_Hosp_Profee_Price 57010 COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS ProFee 57010 CDM 982 RC 57010 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price 57010 COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS ProFee 57010 CDM 982 RC 57010 HCPCS facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price acetaZOLAMIDE 250 mg Tab [INYO] 5702 CDM 00904-6663-61 NDC facility both 1 EA 26 26 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaZOLAMIDE 250 mg Tab [INYO] 5702 CDM 50268-0054-15 NDC facility both 1 EA 25.13 25.13 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaZOLAMIDE 250 mg Tab [INYO] 5702 CDM 68084-0541-01 NDC facility both 1 EA 25.13 25.13 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaZOLAMIDE 250 mg Tab [INYO] 5702 CDM 23155-0288-01 NDC facility both 1 EA 17.3 17.3 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "57065 DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSU ProFee" 57065 CDM 982 RC 57065 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price "57065 DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSU ProFee" 57065 CDM 982 RC 57065 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 57100 BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE PROCEDURE) ProFee 57100 CDM 982 RC 57100 HCPCS facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 57100 BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE PROCEDURE) ProFee 57100 CDM 982 RC 57100 HCPCS facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price digoxin 250 mcg/mL (0.25 mg/mL) Inj Sol [INYO] 5712 CDM J1160 HCPCS 00641-1410-35 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy digoxin 250 mcg/mL (0.25 mg/mL) Inj Sol [INYO] 5712 CDM J1160 HCPCS 70515-0261-10 NDC facility both 2 ML 1520 1520 Gross Charge Type: Pharmacy digoxin 250 mcg/mL (0.25 mg/mL) Inj Sol [INYO] 5712 CDM J1160 HCPCS 00781-3059-95 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy 57120 COLPOCLEISIS (LE FORT TYPE) ProFee 57120 CDM 982 RC 57120 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 57120 COLPOCLEISIS (LE FORT TYPE) ProFee 57120 CDM 982 RC 57120 HCPCS facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 57135 Excision of vaginal cyst or tumor 571351 CDM 521 RC 57135 HCPCS facility both 407 407 Gross Charge Type: NIHD_RHC_Price 57135 EXCISION OF VAGINAL CYST OR TUMOR ProFee 571352 CDM 982 RC 57135 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 57135 EXCISION OF VAGINAL CYST OR TUMOR ProFee 571352 CDM 982 RC 57135 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price digoxin 50 mcg/mL (0.05 mg/mL) Oral Elix [INYO] 5715 CDM 00054-0057-46 NDC facility both 60 ML 672 672 Gross Charge Type: Pharmacy 57160 Fitting and insertion of pessary or other intravaginal support device 57160 CDM 521 RC 57160 HCPCS facility both 239 239 Gross Charge Type: NIHD_RHC_Price 57160 Fitting and insertion of pessary or other intravaginal support device 57160 CDM 521 RC 57160 HCPCS facility both 239 239 Gross Charge Type: NIHD_Clinic_Price 57170 Diaphragm or cervical cap fitting with instructions 57170 CDM 521 RC 57170 HCPCS facility both 126 126 Gross Charge Type: NIHD_RHC_Price 57170 Diaphragm or cervical cap fitting with instructions 57170 CDM 521 RC 57170 HCPCS facility both 126 126 Gross Charge Type: NIHD_Clinic_Price "57200 COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL) ProFee" 57200 CDM 982 RC 57200 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price "57200 COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL) ProFee" 57200 CDM 982 RC 57200 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price "57240 ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE ProFee" 57240 CDM 982 RC 57240 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "57240 ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE ProFee" 57240 CDM 982 RC 57240 HCPCS facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price "57250 POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY ProFee" 57250 CDM 982 RC 57250 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price "57250 POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY ProFee" 57250 CDM 982 RC 57250 HCPCS facility both 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price 57260 COMBINED ANTEROPOSTERIOR COLPORRHAPHY; ProFee 57260 CDM 982 RC 57260 HCPCS facility both 6487 6487 Gross Charge Type: NIHD_Hosp_Profee_Price 57260 COMBINED ANTEROPOSTERIOR COLPORRHAPHY; ProFee 57260 CDM 982 RC 57260 HCPCS facility both 6487 6487 Gross Charge Type: NIHD_Hosp_Profee_Price 57265 COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR ProFee 57265 CDM 982 RC 57265 HCPCS facility both 1548 1548 Gross Charge Type: NIHD_Hosp_Profee_Price 57265 COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR ProFee 57265 CDM 982 RC 57265 HCPCS facility both 1548 1548 Gross Charge Type: NIHD_Hosp_Profee_Price "57267 INSERTION OF MESH OR OTHER PROSTHESIS FOR REPAIR OF PELVIC FLOOR DEFECT, EACH SITE (AN ProFee" 57267 CDM 982 RC 57267 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price "57267 INSERTION OF MESH OR OTHER PROSTHESIS FOR REPAIR OF PELVIC FLOOR DEFECT, EACH SITE (AN ProFee" 57267 CDM 982 RC 57267 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price "57268 REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE) ProFee" 57268 CDM 982 RC 57268 HCPCS facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price "57268 REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE) ProFee" 57268 CDM 982 RC 57268 HCPCS facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price "57270 REPAIR OF ENTEROCELE, ABDOMINAL APPROACH (SEPARATE PROCEDURE) ProFee" 57270 CDM 975 RC 57270 HCPCS facility both 1419 1419 Gross Charge Type: NIHD_Hosp_Profee_Price "57270 REPAIR OF ENTEROCELE, ABDOMINAL APPROACH (SEPARATE PROCEDURE) ProFee" 57270 CDM 975 RC 57270 HCPCS facility both 1419 1419 Gross Charge Type: NIHD_Hosp_Profee_Price "57287 REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC) ProFee" 57287 CDM 982 RC 57287 HCPCS facility both 1266 1266 Gross Charge Type: NIHD_Hosp_Profee_Price "57287 REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC) ProFee" 57287 CDM 982 RC 57287 HCPCS facility both 1266 1266 Gross Charge Type: NIHD_Hosp_Profee_Price "57288 SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC) ProFee" 57288 CDM 982 RC 57288 HCPCS facility both 4118 4118 Gross Charge Type: NIHD_Hosp_Profee_Price "57288 SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC) ProFee" 57288 CDM 982 RC 57288 HCPCS facility both 4118 4118 Gross Charge Type: NIHD_Hosp_Profee_Price 57295 Revision (including removal) of prosthetic vaginal graft; vaginal approach 57295 CDM 521 RC 57295 HCPCS facility both 756 756 Gross Charge Type: NIHD_RHC_Price 57295 Revision (including removal) of prosthetic vaginal graft; vaginal approach 57295 CDM 521 RC 57295 HCPCS facility both 756 756 Gross Charge Type: NIHD_Clinic_Price 57300 CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH ProFee 57300 CDM 982 RC 57300 HCPCS facility both 1038 1038 Gross Charge Type: NIHD_Hosp_Profee_Price 57300 CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH ProFee 57300 CDM 982 RC 57300 HCPCS facility both 1038 1038 Gross Charge Type: NIHD_Hosp_Profee_Price 57410 PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL) ProFee 57410 CDM 982 RC 57410 HCPCS facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price 57410 PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL) ProFee 57410 CDM 982 RC 57410 HCPCS facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price "57420 Colposcopy of the entire vagina, with cervix if present;" 57420 CDM 521 RC 57420 HCPCS facility both 508 508 Gross Charge Type: NIHD_RHC_Price "57421 COLPOSCOPY OF THE ENTIRE VAGINA, W/ CERVIX IF PRESENT; W/ BX OF VAGINA/CERVIX" 57421 CDM 521 RC 57421 HCPCS facility both 550 550 Gross Charge Type: NIHD_RHC_Price "57421 COLPOSCOPY OF THE ENTIRE VAGINA, W/ CERVIX IF PRESENT; W/ BX OF VAGINA/CERVIX" 57421 CDM 521 RC 57421 HCPCS facility both 550 550 Gross Charge Type: NIHD_Clinic_Price "57425 LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX) ProFee" 57425 CDM 982 RC 57425 HCPCS facility both 1897 1897 Gross Charge Type: NIHD_Hosp_Profee_Price "57425 LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX) ProFee" 57425 CDM 982 RC 57425 HCPCS facility both 1897 1897 Gross Charge Type: NIHD_Hosp_Profee_Price FLUoxetine 20 mg Cap [INYO] 5743 CDM 00904-5785-61 NDC facility both 1 EA 14.9 14.9 Gross Charge Type: Pharmacy | NDC EA = 1 CAP diltiazem 180 mg/24 hours ERCap [INYO] 5744 CDM 60687-0206-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP dilTIAZem 180 mg/24 hours Cap [INYO] 5744 CDM 00904-7218-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP diltiazem 180 mg/24 hours ERCap [INYO] 5744 CDM 51079-0948-08 NDC facility both 1 EA 7.22 7.22 Gross Charge Type: Pharmacy | NDC EA = 1 CAP diltiazem 120 mg/24 hours ERCap [INYO] 5745 CDM 60687-0195-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP dilTIAZem 120 mg/24 hours ER Cap [INYO] 5745 CDM 00904-7217-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP diltiazem 120 mg/24 hours ERCap [INYO] 5745 CDM 51079-0947-08 NDC facility both 1 EA 6.15 6.15 Gross Charge Type: Pharmacy | NDC EA = 1 CAP 57452 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; ProFee 57452 CDM 982 RC 57452 HCPCS facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price 57452 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; ProFee 57452 CDM 982 RC 57452 HCPCS facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price 57454 Colposcopy of the cervix incl. vagina; w/ biopsy of cervix and endocervical curettage 57454 CDM 521 RC 57454 HCPCS facility both 582 582 Gross Charge Type: NIHD_RHC_Price 57455 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix 57455 CDM 521 RC 57455 HCPCS facility both 403 403 Gross Charge Type: NIHD_RHC_Price 57456 Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage 57456 CDM 521 RC 57456 HCPCS facility both 234 234 Gross Charge Type: NIHD_RHC_Price 57456 Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage 57456 CDM 521 RC 57456 HCPCS facility both 234 234 Gross Charge Type: NIHD_Clinic_Price 57460 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S ProFee 57460 CDM 982 RC 57460 HCPCS facility both 835 835 Gross Charge Type: NIHD_Hosp_Profee_Price 57460 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S ProFee 57460 CDM 982 RC 57460 HCPCS facility both 835 835 Gross Charge Type: NIHD_Hosp_Profee_Price 57461 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATI ProFee 57461 CDM 982 RC 57461 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price 57461 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATI ProFee 57461 CDM 982 RC 57461 HCPCS facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price dilTIAZem 25 mg/mL 5 mL Sol [INYO] 5749 CDM 00641-6013-10 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy dilTIAZem 25 mg/mL 5 mL Sol [INYO] 5749 CDM 17478-0937-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy dilTIAZem 25 mg/mL 5 mL Sol [INYO] 5749 CDM 70860-0301-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy "57500 Biopsy of cervix, single or multiple, or local excision of lesion, w/ or w/o fulguration" 575001 CDM 521 RC 57500 HCPCS facility both 582 582 Gross Charge Type: NIHD_RHC_Price "57500 BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FUL ProFee" 575002 CDM 982 RC 57500 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price "57500 BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FUL ProFee" 575002 CDM 982 RC 57500 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 57505 Endocervical curettage 575051 CDM 521 RC 57505 HCPCS facility both 233 233 Gross Charge Type: NIHD_RHC_Price 57505 Endocervical curettage 575051 CDM 521 RC 57505 HCPCS facility both 233 233 Gross Charge Type: NIHD_Clinic_Price 57505 ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE) ProFee 575052 CDM 982 RC 57505 HCPCS facility both 179 179 Gross Charge Type: NIHD_Hosp_Profee_Price 57505 ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE) ProFee 575052 CDM 982 RC 57505 HCPCS facility both 179 179 Gross Charge Type: NIHD_Hosp_Profee_Price "57522 CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETT ProFee" 57522 CDM 982 RC 57522 HCPCS facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price "57522 CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETT ProFee" 57522 CDM 982 RC 57522 HCPCS facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price dilTIAZem 240 mg/24 hours ERCap [INYO] 5753 CDM 00904-7219-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP diltiazem 240 mg/24 hours ERCap [INYO] 5753 CDM 51079-0949-08 NDC facility both 1 EA 7.78 7.78 Gross Charge Type: Pharmacy | NDC EA = 1 CAP diltiazem 240 mg/24 hours ERCap [INYO] 5753 CDM 60687-0217-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP diltiazem 240 mg/24 hours ERCap [INYO] 5753 CDM 63739-0016-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP bisacodyl 10 mg Supp [INYO] 5759 CDM 00574-7050-50 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP bisacodyl 10 mg Supp [INYO] 5759 CDM 00713-0109-01 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP dicloxacillin 250 mg Cap [INYO] 5767 CDM 00093-3123-01 NDC facility both 1 EA 8.27 8.27 Gross Charge Type: Pharmacy | NDC EA = 1 CAP doxazosin 2 mg Tab [INYO] 5768 CDM 00904-5523-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB doxazosin 2 mg Tab [inyo] 5768 CDM 68084-0851-01 NDC facility both 1 EA 6.55 6.55 Gross Charge Type: Pharmacy | NDC EA = 1 TAB EPIEFFECT 7 cm x 7 cm sheet 5770003 CDM 636 RC facility both 1178 1178 Gross Charge Type: NIHD_Hosp_Profee_Price EPIEFFECT 7 cm x 7 cm sheet 5770003 CDM 636 RC facility both 1178 1178 Gross Charge Type: NIHD_Hosp_Profee_Price dipyridamole 25 mg Tab [INYO] 5775 CDM 00054-0434-25 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "57800 Dilation of cervical canal, instrumental (separate procedure)" 57800 CDM 521 RC 57800 HCPCS facility both 2830 2830 Gross Charge Type: NIHD_RHC_Price ePHEDrine 50 mg/mL Sol [inyo] 5791 CDM 70756-0611-25 NDC facility both 1 ML 240.1 240.1 Gross Charge Type: Pharmacy ePHEDrine 50 mg/mL [INYO] 5791 CDM 42023-0216-25 NDC facility both 1 ML 278.78 278.78 Gross Charge Type: Pharmacy methylergonovine 0.2 mg/mL Inj Sol [INYO] 5798 CDM J2210 HCPCS 51991-0144-17 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy methylergonovine 0.2 mg/mL Inj Sol [INYO] 5798 CDM J2210 HCPCS 00517-0740-20 NDC facility both 1 ML 260.35 260.35 Gross Charge Type: Pharmacy methylergonovine 0.2 mg Tab [INYO] 5799 CDM 60687-0410-94 NDC facility both 1 EA 264 264 Gross Charge Type: Pharmacy erythromycin ophthalmic 0.5% Oint 3.5 g [INYO] 5800 CDM 24208-0910-55 NDC facility both 1 EA 95 95 Gross Charge Type: Pharmacy | NDC EA = 3.5 APP erythromycin ophthalmic 0.5% Oint 3.5 g [INYO] 5800 CDM 00574-4024-35 NDC facility both 1 EA 89.8 89.8 Gross Charge Type: Pharmacy | NDC EA = 3.5 APP erythromycin ophthalmic 0.5% Oint 3.5 g [INYO] 5800 CDM 17478-0070-35 NDC facility both 1 EA 93.25 93.25 Gross Charge Type: Pharmacy | NDC EA = 3.5 APP erythromycin Ophth 0.5% 1 g Oint [INYO] 5801 CDM 24208-0910-19 NDC facility both 1 EA 62.07 62.07 Gross Charge Type: Pharmacy | NDC EA = 1 APP erythromycin Ophth 0.5% 1 g Oint [INYO] 5801 CDM 00574-4024-50 NDC facility both 1 EA 43.48 43.48 Gross Charge Type: Pharmacy | NDC EA = 1 APP erythromycin Ophth 0.5% 1 g Oint [INYO] 5801 CDM 17478-0070-31 NDC facility both 1 EA 51.09 51.09 Gross Charge Type: Pharmacy | NDC EA = 1 APP "58100 Endometrial biopsy with or w/o endocer biopsy, w/o cervical dilation, any method" 58100 CDM 521 RC 58100 HCPCS facility both 501 501 Gross Charge Type: NIHD_RHC_Price "58100 Endometrial biopsy with or w/o endocer biopsy, w/o cervical dilation, any method" 58100 CDM 521 RC 58100 HCPCS facility both 501 501 Gross Charge Type: NIHD_Clinic_Price 58100 Endometrial Sample BX w/wo cerv bx 581001 CDM 450 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price 58100 Endometrial Sample BX w/wo cerv bx 581001 CDM 450 RC facility both 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price "58100 ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT ProFee" 581002 CDM 982 RC 58100 HCPCS facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price "58100 ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT ProFee" 581002 CDM 982 RC 58100 HCPCS facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price esmolol 100 mg/10 mL IV Sol [INYO] 5811 CDM J1805 HCPCS 55150-0194-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy 58110 Endometrial Biopsy performed with Colposcopy 58110 CDM 521 RC 58110 HCPCS facility both 152 152 Gross Charge Type: NIHD_RHC_Price 58110 Endometrial Biopsy performed with Colposcopy 58110 CDM 521 RC 58110 HCPCS facility both 152 152 Gross Charge Type: NIHD_Clinic_Price "58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL) ProFee" 58120 CDM 982 RC 58120 HCPCS facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price "58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL) ProFee" 58120 CDM 982 RC 58120 HCPCS facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price "58140 MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TO ProFee" 58140 CDM 982 RC 58140 HCPCS facility both 1592 1592 Gross Charge Type: NIHD_Hosp_Profee_Price "58140 MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TO ProFee" 58140 CDM 982 RC 58140 HCPCS facility both 1592 1592 Gross Charge Type: NIHD_Hosp_Profee_Price "58145 MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TO ProFee" 58145 CDM 982 RC 58145 HCPCS facility both 1075 1075 Gross Charge Type: NIHD_Hosp_Profee_Price "58145 MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TO ProFee" 58145 CDM 982 RC 58145 HCPCS facility both 1075 1075 Gross Charge Type: NIHD_Hosp_Profee_Price "58150 TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), ProFee" 58150 CDM 982 RC 58150 HCPCS facility both 4865 4865 Gross Charge Type: NIHD_Hosp_Profee_Price "58150 TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), ProFee" 58150 CDM 982 RC 58150 HCPCS facility both 4865 4865 Gross Charge Type: NIHD_Hosp_Profee_Price fluconazole 200 mg in NS 100 mL Premix IVPB [INYO] 5823 CDM J1450 HCPCS 25021-0184-82 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy fluconazole 200 mg in NS 100 mL Premix IVPB [INYO] 5823 CDM J1450 HCPCS 00409-4688-18 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy fluconazole 100 mg Tab [INYO] 5824 CDM 00904-6500-61 NDC facility both 1 EA 58.25 58.25 Gross Charge Type: Pharmacy | NDC EA = 1 TAB fluconazole 100 mg Tab [INYO] 5824 CDM 68084-0728-01 NDC facility both 1 EA 120 120 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "58262 VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY( ProFee" 58262 CDM 982 RC 58262 HCPCS facility both 4517 4517 Gross Charge Type: NIHD_Hosp_Profee_Price "58262 VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY( ProFee" 58262 CDM 982 RC 58262 HCPCS facility both 4517 4517 Gross Charge Type: NIHD_Hosp_Profee_Price "58263 VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY( ProFee" 58263 CDM 982 RC 58263 HCPCS facility both 4990 4990 Gross Charge Type: NIHD_Hosp_Profee_Price "58263 VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY( ProFee" 58263 CDM 982 RC 58263 HCPCS facility both 4990 4990 Gross Charge Type: NIHD_Hosp_Profee_Price "58270 VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REPAIR OF ENTEROCELE ProFee" 58270 CDM 982 RC 58270 HCPCS facility both 1562 1562 Gross Charge Type: NIHD_Hosp_Profee_Price "58270 VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REPAIR OF ENTEROCELE ProFee" 58270 CDM 982 RC 58270 HCPCS facility both 1562 1562 Gross Charge Type: NIHD_Hosp_Profee_Price "58292 VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OV ProFee" 58292 CDM 982 RC 58292 HCPCS facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price "58292 VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OV ProFee" 58292 CDM 982 RC 58292 HCPCS facility both 2329 2329 Gross Charge Type: NIHD_Hosp_Profee_Price 58300 Insertion of intrauterine device (IUD) 583001 CDM 521 RC 58300 HCPCS facility both 398 398 Gross Charge Type: NIHD_RHC_Price 58300 INSERTION OF INTRAUTERINE DEVICE (IUD) ProFee 583002 CDM 982 RC 58300 HCPCS facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 58300 INSERTION OF INTRAUTERINE DEVICE (IUD) ProFee 583002 CDM 982 RC 58300 HCPCS facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 58301 Removal of intrauterine device (IUD) 583011 CDM 521 RC 58301 HCPCS facility both 301 301 Gross Charge Type: NIHD_RHC_Price 58301 REMOVAL OF INTRAUTERINE DEVICE (IUD) EDProFee 583012 CDM 982 RC 58301 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price 58301 REMOVAL OF INTRAUTERINE DEVICE (IUD) EDProFee 583012 CDM 982 RC 58301 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price 58301 REMOVAL INTRAUTERINE DEVICE IUD TechFee 583013 CDM 450 RC facility both 559 559 Gross Charge Type: NIHD_Hosp_Profee_Price 58301 REMOVAL INTRAUTERINE DEVICE IUD TechFee 583013 CDM 450 RC facility both 559 559 Gross Charge Type: NIHD_Hosp_Profee_Price 58301 REMOVAL IUD CHARGE 583014 CDM 360 RC facility both 559 559 Gross Charge Type: NIHD_Hosp_Profee_Price 58301 REMOVAL IUD CHARGE 583014 CDM 360 RC facility both 559 559 Gross Charge Type: NIHD_Hosp_Profee_Price ferrous sulfate 325 mg Tab [INYO] 5833 CDM 00904-7591-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ferrous sulfate 325 mg Tab [INYO] 5833 CDM 10006-0700-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 58340 Catheterization and introduction of saline or contrast material for infusion 583401 CDM 521 RC 58340 HCPCS facility both 354 354 Gross Charge Type: NIHD_RHC_Price 58340 CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR SALINE INFUSION SO ProFee 583402 CDM 982 RC 58340 HCPCS facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price 58340 CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR SALINE INFUSION SO ProFee 583402 CDM 982 RC 58340 HCPCS facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price 58340 XR HYSTERO (CATH INSERT W/CON) 583403 CDM 329 RC facility both 605 605 Gross Charge Type: NIHD_Hosp_Profee_Price 58340 XR HYSTERO (CATH INSERT W/CON) 583403 CDM 329 RC facility both 605 605 Gross Charge Type: NIHD_Hosp_Profee_Price 58340 XR HYSTERO CATH INSERT PROF 583404 CDM 972 RC 58340 HCPCS facility both 86 86 Gross Charge Type: NIHD_Hosp_Tech_Price 58340 XR HYSTERO CATH INSERT PROF 583404 CDM 972 RC 58340 HCPCS facility both 86 86 Gross Charge Type: NIHD_Hosp_Tech_Price flumazenil 0.5 mg/5 mL IV Sol [INYO] 5835 CDM 00143-9784-10 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy flumazenil 0.5 mg/5 mL IV Sol [INYO] 5835 CDM 63323-0424-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy flumazenil 0.5 mg/5 mL IV Sol [INYO] 5835 CDM 36000-0148-10 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy "58350 CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS ProFee" 58350 CDM 982 RC 58350 HCPCS facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price "58350 CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS ProFee" 58350 CDM 982 RC 58350 HCPCS facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price "58353 ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE ProFee" 58353 CDM 982 RC 58353 HCPCS facility both 399 399 Gross Charge Type: NIHD_Hosp_Profee_Price "58353 ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE ProFee" 58353 CDM 982 RC 58353 HCPCS facility both 399 399 Gross Charge Type: NIHD_Hosp_Profee_Price APAP/butalbital/caffeine 325 mg-50 mg-40 mg Tab [INYO] 5836 CDM 00603-2544-21 NDC facility both 1 EA 10.13 10.13 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metroNIDAZOLE 250 mg Tab [INYO] 5838 CDM 50268-0534-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metroNIDAZOLE 250 mg Tab [INYO] 5838 CDM 00904-1453-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metroNIDAZOLE 500 mg/100 mL IV Sol [INYO] 5839 CDM J1836 HCPCS 00409-0152-24 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy metroNIDAZOLE 500 mg/100 mL IV Sol [INYO] 5839 CDM J1836 HCPCS 00409-7811-24 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy metroNIDAZOLE 500 mg/100 mL IV Sol [INYO] 5839 CDM J1836 HCPCS 00338-1055-48 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy metroNIDAZOLE 500 mg/100 mL IV Sol [INYO] 5839 CDM J1836 HCPCS 25021-0131-82 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy "58400 UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUND LIGAMENTS, WITH OR WITHOUT SHO ProFee" 58400 CDM 982 RC 58400 HCPCS facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price "58400 UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUND LIGAMENTS, WITH OR WITHOUT SHO ProFee" 58400 CDM 982 RC 58400 HCPCS facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price folic acid 1 mg Tab [INYO] 5846 CDM 00904-7224-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB folic acid 1 mg Tab [INYO] 5846 CDM 60687-0681-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB folic acid 1 mg Tab [INYO] 5846 CDM 62584-0897-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB folic acid 1 mg Tab [INYO] 5846 CDM 00904-6582-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB folic acid 5 mg/mL Inj Sol [INYO] 5848 CDM J3490 HCPCS 63323-0184-10 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy "58542 LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMO ProFee" 58542 CDM 982 RC 58542 HCPCS facility both 3813 3813 Gross Charge Type: NIHD_Hosp_Profee_Price "58542 LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMO ProFee" 58542 CDM 982 RC 58542 HCPCS facility both 3813 3813 Gross Charge Type: NIHD_Hosp_Profee_Price "58544 LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH ProFee" 58544 CDM 982 RC 58544 HCPCS facility both 4366 4366 Gross Charge Type: NIHD_Hosp_Profee_Price "58544 LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH ProFee" 58544 CDM 982 RC 58544 HCPCS facility both 4366 4366 Gross Charge Type: NIHD_Hosp_Profee_Price "58546 LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAM ProFee" 58546 CDM 982 RC 58546 HCPCS facility both 1961 1961 Gross Charge Type: NIHD_Hosp_Profee_Price "58546 LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAM ProFee" 58546 CDM 982 RC 58546 HCPCS facility both 1961 1961 Gross Charge Type: NIHD_Hosp_Profee_Price "58550 LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; ProFee" 58550 CDM 975 RC 58550 HCPCS facility both 1548 1548 Gross Charge Type: NIHD_Hosp_Profee_Price "58550 LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; ProFee" 58550 CDM 975 RC 58550 HCPCS facility both 1548 1548 Gross Charge Type: NIHD_Hosp_Profee_Price "58552 LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOV ProFee" 58552 CDM 982 RC 58552 HCPCS facility both 3992 3992 Gross Charge Type: NIHD_Hosp_Profee_Price "58552 LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOV ProFee" 58552 CDM 982 RC 58552 HCPCS facility both 3992 3992 Gross Charge Type: NIHD_Hosp_Profee_Price "58553 LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; ProFee" 58553 CDM 982 RC 58553 HCPCS facility both 4616 4616 Gross Charge Type: NIHD_Hosp_Profee_Price "58553 LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; ProFee" 58553 CDM 982 RC 58553 HCPCS facility both 4616 4616 Gross Charge Type: NIHD_Hosp_Profee_Price "58554 LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH ProFee" 58554 CDM 982 RC 58554 HCPCS facility both 5115 5115 Gross Charge Type: NIHD_Hosp_Profee_Price "58554 LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH ProFee" 58554 CDM 982 RC 58554 HCPCS facility both 5115 5115 Gross Charge Type: NIHD_Hosp_Profee_Price "58555 HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE) ProFee" 58555 CDM 982 RC 58555 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price "58555 HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE) ProFee" 58555 CDM 982 RC 58555 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price "58558 HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH ProFee" 58558 CDM 982 RC 58558 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "58558 HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH ProFee" 58558 CDM 982 RC 58558 HCPCS facility both 1685 1685 Gross Charge Type: NIHD_Hosp_Profee_Price "58561 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA ProFee" 58561 CDM 982 RC 58561 HCPCS facility both 3244 3244 Gross Charge Type: NIHD_Hosp_Profee_Price "58561 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA ProFee" 58561 CDM 982 RC 58561 HCPCS facility both 3244 3244 Gross Charge Type: NIHD_Hosp_Profee_Price "58562 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY ProFee" 58562 CDM 982 RC 58562 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price "58562 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY ProFee" 58562 CDM 982 RC 58562 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price "58563 HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROS ProFee" 58563 CDM 982 RC 58563 HCPCS facility both 5738 5738 Gross Charge Type: NIHD_Hosp_Profee_Price "58563 HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROS ProFee" 58563 CDM 982 RC 58563 HCPCS facility both 5738 5738 Gross Charge Type: NIHD_Hosp_Profee_Price "58570 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; ProFee" 58570 CDM 975 RC 58570 HCPCS facility both 1387 1387 Gross Charge Type: NIHD_Hosp_Profee_Price "58570 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; ProFee" 58570 CDM 975 RC 58570 HCPCS facility both 1387 1387 Gross Charge Type: NIHD_Hosp_Profee_Price "58571 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL ProFee" 58571 CDM 982 RC 58571 HCPCS facility both 4366 4366 Gross Charge Type: NIHD_Hosp_Profee_Price "58571 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL ProFee" 58571 CDM 982 RC 58571 HCPCS facility both 4366 4366 Gross Charge Type: NIHD_Hosp_Profee_Price "58572 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; ProFee" 58572 CDM 982 RC 58572 HCPCS facility both 4616 4616 Gross Charge Type: NIHD_Hosp_Profee_Price "58572 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; ProFee" 58572 CDM 982 RC 58572 HCPCS facility both 4616 4616 Gross Charge Type: NIHD_Hosp_Profee_Price "58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH RE ProFee" 58573 CDM 982 RC 58573 HCPCS facility both 5365 5365 Gross Charge Type: NIHD_Hosp_Profee_Price "58573 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH RE ProFee" 58573 CDM 982 RC 58573 HCPCS facility both 5365 5365 Gross Charge Type: NIHD_Hosp_Profee_Price "58578 UNLISTED LAPAROSCOPY PROCEDURE, UTERUS ProFee" 58578 CDM 982 RC 58578 HCPCS facility both 1624 1624 Gross Charge Type: NIHD_Hosp_Profee_Price "58578 UNLISTED LAPAROSCOPY PROCEDURE, UTERUS ProFee" 58578 CDM 982 RC 58578 HCPCS facility both 1624 1624 Gross Charge Type: NIHD_Hosp_Profee_Price "58579 UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS ProFee" 58579 CDM 975 RC 58579 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price "58579 UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS ProFee" 58579 CDM 975 RC 58579 HCPCS facility both 2059 2059 Gross Charge Type: NIHD_Hosp_Profee_Price "58600 LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, UNILATERA ProFee" 58600 CDM 982 RC 58600 HCPCS facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price "58600 LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, UNILATERA ProFee" 58600 CDM 982 RC 58600 HCPCS facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price 58611 Ligation/transection of fallopian tube(s); cesarean delivery or intra-abdominal surgery 586111 CDM 521 RC 58611 HCPCS facility both 1306 1306 Gross Charge Type: NIHD_RHC_Price 58611 LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S) WHEN DONE AT THE TIME OF CESAREAN DELIVER ProFee 586112 CDM 982 RC 58611 HCPCS facility both 1306 1306 Gross Charge Type: NIHD_Hosp_Profee_Price 58611 LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S) WHEN DONE AT THE TIME OF CESAREAN DELIVER ProFee 586112 CDM 982 RC 58611 HCPCS facility both 1306 1306 Gross Charge Type: NIHD_Hosp_Profee_Price "58615 OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND, CLIP, FALOPE RING) VAGINAL OR SUPR ProFee" 58615 CDM 982 RC 58615 HCPCS facility both 441 441 Gross Charge Type: NIHD_Hosp_Profee_Price "58615 OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND, CLIP, FALOPE RING) VAGINAL OR SUPR ProFee" 58615 CDM 982 RC 58615 HCPCS facility both 441 441 Gross Charge Type: NIHD_Hosp_Profee_Price nitrofurantoin macrocrystals 50 mg Cap [INYO] 5863 CDM 50268-0623-15 NDC facility both 1 EA 26.51 26.51 Gross Charge Type: Pharmacy | NDC EA = 1 CAP nitrofurantoin macrocrystals-monohydrate 100 mg Cap [INYO] 5864 CDM 65162-0478-10 NDC facility both 1 EA 35.6 35.6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP nitrofurantoin macrocrystals-monohydrate 100 mg Cap [INYO] 5864 CDM 47781-0303-01 NDC facility both 1 EA 22.88 22.88 Gross Charge Type: Pharmacy | NDC EA = 1 CAP nitrofurantoin macrocrystals-monohydrate 100 mg Cap [INYO] 5864 CDM 00378-3422-01 NDC facility both 1 EA 19.23 19.23 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "58660 LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE ProFee" 58660 CDM 982 RC 58660 HCPCS facility both 3258 3258 Gross Charge Type: NIHD_Hosp_Profee_Price "58660 LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE ProFee" 58660 CDM 982 RC 58660 HCPCS facility both 3258 3258 Gross Charge Type: NIHD_Hosp_Profee_Price "58661 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTO ProFee" 58661 CDM 982 RC 58661 HCPCS facility both 3244 3244 Gross Charge Type: NIHD_Hosp_Profee_Price "58661 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTO ProFee" 58661 CDM 982 RC 58661 HCPCS facility both 3244 3244 Gross Charge Type: NIHD_Hosp_Profee_Price "58662 LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VI ProFee" 58662 CDM 982 RC 58662 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "58662 LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VI ProFee" 58662 CDM 982 RC 58662 HCPCS facility both 1435 1435 Gross Charge Type: NIHD_Hosp_Profee_Price "58670 LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION) ProFee" 58670 CDM 982 RC 58670 HCPCS facility both 651 651 Gross Charge Type: NIHD_Hosp_Profee_Price "58670 LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION) ProFee" 58670 CDM 982 RC 58670 HCPCS facility both 651 651 Gross Charge Type: NIHD_Hosp_Profee_Price "58679 UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY ProFee" 58679 CDM 982 RC 58679 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price "58679 UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY ProFee" 58679 CDM 982 RC 58679 HCPCS facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price immune globulin IM Sol 2 mL [INYO] 5870 CDM J1460 HCPCS 13533-0635-04 NDC facility both 2 ML 391.04 391.04 Gross Charge Type: Pharmacy "58700 Salpingectomy, complete or partial, unilateral or bilateral" 587001 CDM 521 RC 58700 HCPCS facility both 3046 3046 Gross Charge Type: NIHD_RHC_Price "58700 SALPINGECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE) ProFee" 587002 CDM 982 RC 58700 HCPCS facility both 2994 2994 Gross Charge Type: NIHD_Hosp_Profee_Price "58700 SALPINGECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE) ProFee" 587002 CDM 982 RC 58700 HCPCS facility both 2994 2994 Gross Charge Type: NIHD_Hosp_Profee_Price gentamicin 80 mg/2 mL Inj Sol [INYO] 5881 CDM J1580 HCPCS 63323-0010-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy gentamicin 80 mg/2 mL Inj Sol [INYO] 5881 CDM J1580 HCPCS 00409-1207-03 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy vitamin A & D Top Oint [INYO] 5884 CDM 00168-0035-01 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 56.7 APP SAHARA CHEST TUBE DRAINAGE SYSTEM 5888654 CDM 272 RC facility both 422 422 Gross Charge Type: NIHD_Hosp_Profee_Price SAHARA CHEST TUBE DRAINAGE SYSTEM 5888654 CDM 272 RC facility both 422 422 Gross Charge Type: NIHD_Hosp_Profee_Price SAHARA MINI CHEST TUBE DRAINAGE SYSTEM 5888655 CDM 272 RC facility both 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price SAHARA MINI CHEST TUBE DRAINAGE SYSTEM 5888655 CDM 272 RC facility both 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price "58925 OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL ProFee" 58925 CDM 982 RC 58925 HCPCS facility both 2746 2746 Gross Charge Type: NIHD_Hosp_Profee_Price "58925 OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL ProFee" 58925 CDM 982 RC 58925 HCPCS facility both 2746 2746 Gross Charge Type: NIHD_Hosp_Profee_Price 58999 Other Procedures on the Female Genital 58999 CDM 521 RC 58999 HCPCS facility both 398 398 Gross Charge Type: NIHD_RHC_Price 58999 Other Procedures on the Female Genital 58999 CDM 521 RC 58999 HCPCS facility both 398 398 Gross Charge Type: NIHD_Clinic_Price 59000 Amniocentesis 59000 CDM 721 RC facility both 1006 1006 Gross Charge Type: NIHD_Hosp_Profee_Price 59000 Amniocentesis 59000 CDM 721 RC facility both 1006 1006 Gross Charge Type: NIHD_Hosp_Profee_Price Fetal Contraction Stress Test 59020 CDM 721 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price Fetal Contraction Stress Test 59020 CDM 721 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 59025 Fetal non-stress test 590251 CDM 521 RC 59025 HCPCS facility both 111 111 Gross Charge Type: NIHD_RHC_Price 59025 PF-FETAL NON-STRESS TEST 590252 CDM 982 RC 59025 HCPCS facility both 26 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price 59025 PF-FETAL NON-STRESS TEST 590252 CDM 982 RC 59025 HCPCS facility both 26 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price Fetal Non-Stress Test 590253 CDM 761 RC facility both 668 668 Gross Charge Type: NIHD_Hosp_Profee_Price Fetal Non-Stress Test 590253 CDM 761 RC facility both 668 668 Gross Charge Type: NIHD_Hosp_Profee_Price glucagon 1 mg Inj [INYO] 5904 CDM J1610 HCPCS 00548-5850-00 NDC facility both 1 EA 2016 2016 Gross Charge Type: Pharmacy glucagon 1 mg Inj [INYO] 5904 CDM J1610 HCPCS 00169-7065-15 NDC facility both 1 EA 2109.96 2109.96 Gross Charge Type: Pharmacy "Equistream Catheter Straight, Microintroducer Kit 14.5 Fr X 19 CM" 5904190 CDM 272 RC facility both 1161 1161 Gross Charge Type: NIHD_Hosp_Profee_Price "Equistream Catheter Straight, Microintroducer Kit 14.5 Fr X 19 CM" 5904190 CDM 272 RC facility both 1161 1161 Gross Charge Type: NIHD_Hosp_Profee_Price "Equistream Catheter Straight, Microintroducer Kit 14.5 Fr X 23 CM" 5904230 CDM 272 RC facility both 1161 1161 Gross Charge Type: NIHD_Hosp_Profee_Price "Equistream Catheter Straight, Microintroducer Kit 14.5 Fr X 23 CM" 5904230 CDM 272 RC facility both 1161 1161 Gross Charge Type: NIHD_Hosp_Profee_Price glyBURIDE 5 mg Tab [INYO] 5905 CDM 23155-0058-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB glyBURIDE 5 mg Tab [INYO] 5905 CDM 51079-0873-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "59050 FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICIAN) WI ProFee" 59050 CDM 960 RC 59050 HCPCS facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "59050 FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICIAN) WI ProFee" 59050 CDM 960 RC 59050 HCPCS facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price "59051 FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICIAN) WI ProFee" 59051 CDM 982 RC 59051 HCPCS facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price "59051 FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICIAN) WI ProFee" 59051 CDM 982 RC 59051 HCPCS facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price glycerin adult Supp [INYO] 5906 CDM 58980-0410-12 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP glycerin adult Supp [INYO] 5906 CDM 00132-0079-12 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP glycerin adult Supp [INYO] 5906 CDM 00713-0101-09 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP glycerin pediatric Supp [INYO] 5908 CDM 58980-0409-12 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP glycerin pediatric Supp [INYO] 5908 CDM 00713-0102-09 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP haloperidol 1 mg Tab [INYO] 5915 CDM 51079-0734-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB haloperidol 1 mg Tab [inyo] 5915 CDM 00904-7390-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB haloperidol 1 mg Tab [INYO] 5915 CDM 00904-7241-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB haloperidol 1 mg Tab [INYO] 5915 CDM 00781-1392-13 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 59150 LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY ProFee 59150 CDM 982 RC 59150 HCPCS facility both 1353 1353 Gross Charge Type: NIHD_Hosp_Profee_Price 59150 LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY ProFee 59150 CDM 982 RC 59150 HCPCS facility both 1353 1353 Gross Charge Type: NIHD_Hosp_Profee_Price 59151 LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY ProFee 59151 CDM 982 RC 59151 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price 59151 LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY ProFee 59151 CDM 982 RC 59151 HCPCS facility both 1498 1498 Gross Charge Type: NIHD_Hosp_Profee_Price "59160 CURETTAGE, POSTPARTUM ProFee" 59160 CDM 982 RC 59160 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price "59160 CURETTAGE, POSTPARTUM ProFee" 59160 CDM 982 RC 59160 HCPCS facility both 1747 1747 Gross Charge Type: NIHD_Hosp_Profee_Price haloperidol 5 mg/mL Inj Sol [INYO] 5918 CDM J1630 HCPCS 67457-0426-12 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy haloperidol 5 mg/mL Inj Sol [INYO] 5918 CDM J1630 HCPCS 00143-9501-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy "59200 Insertion of cervical dilator (eg, laminaria, prostaglandin)" 592001 CDM 521 RC 59200 HCPCS facility both 159 159 Gross Charge Type: NIHD_RHC_Price "59200 Insertion of cervical dilator (eg, laminaria, prostaglandin)" 592001 CDM 521 RC 59200 HCPCS facility both 159 159 Gross Charge Type: NIHD_Clinic_Price 59200 INSERTION OF CERVICAL DILATOR CHARGE 592002 CDM 361 RC facility both 459 459 Gross Charge Type: NIHD_Hosp_Profee_Price 59200 INSERTION OF CERVICAL DILATOR CHARGE 592002 CDM 361 RC facility both 459 459 Gross Charge Type: NIHD_Hosp_Profee_Price 59200 INTRODUCTION PROCEDURES FOR MATERNITY CARE AND DELIVERY 592003 CDM 982 RC 59200 HCPCS facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 59200 INTRODUCTION PROCEDURES FOR MATERNITY CARE AND DELIVERY 592003 CDM 982 RC 59200 HCPCS facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price "59300 EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING ProFee" 59300 CDM 975 RC 59300 HCPCS facility both 247 247 Gross Charge Type: NIHD_Hosp_Profee_Price "59300 EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING ProFee" 59300 CDM 975 RC 59300 HCPCS facility both 247 247 Gross Charge Type: NIHD_Hosp_Profee_Price "59300 EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING TechFee" 593001 CDM 450 RC facility both 8937 8937 Gross Charge Type: NIHD_Hosp_Profee_Price "59300 EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING TechFee" 593001 CDM 450 RC facility both 8937 8937 Gross Charge Type: NIHD_Hosp_Profee_Price "59320 CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL ProFee" 59320 CDM 975 RC 59320 HCPCS facility both 254 254 Gross Charge Type: NIHD_Hosp_Profee_Price "59320 CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL ProFee" 59320 CDM 975 RC 59320 HCPCS facility both 254 254 Gross Charge Type: NIHD_Hosp_Profee_Price "59400 Routine obstetric care including antepartum care, vaginal delivery, postpartum care" 594002 CDM 521 RC 59400 HCPCS facility both 5801 5801 Gross Charge Type: NIHD_RHC_Price "59400 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EP ProFee" 594003 CDM 982 RC 59400 HCPCS facility both 5801 5801 Gross Charge Type: NIHD_Hosp_Profee_Price "59400 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EP ProFee" 594003 CDM 982 RC 59400 HCPCS facility both 5801 5801 Gross Charge Type: NIHD_Hosp_Profee_Price 59409 VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); ProFee 59409 CDM 982 RC 59409 HCPCS facility both 3046 3046 Gross Charge Type: NIHD_Hosp_Profee_Price 59409 VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); ProFee 59409 CDM 982 RC 59409 HCPCS facility both 3046 3046 Gross Charge Type: NIHD_Hosp_Profee_Price 59412 EXTERNAL CEPHALIC VERSION OB CHARGE 594121 CDM 721 RC facility both 1932 1932 Gross Charge Type: NIHD_Hosp_Profee_Price 59412 EXTERNAL CEPHALIC VERSION OB CHARGE 594121 CDM 721 RC facility both 1932 1932 Gross Charge Type: NIHD_Hosp_Profee_Price "59412 External cephalic version, with or w/o tocolysis" 594122 CDM 982 RC 59412 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "59412 External cephalic version, with or w/o tocolysis" 594122 CDM 982 RC 59412 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price 59414 DELIVERY OF PLACENTA (SEPARATE PROCEDURE) ProFee 59414 CDM 960 RC 59414 HCPCS facility both 156 156 Gross Charge Type: NIHD_Hosp_Profee_Price 59414 DELIVERY OF PLACENTA (SEPARATE PROCEDURE) ProFee 59414 CDM 960 RC 59414 HCPCS facility both 156 156 Gross Charge Type: NIHD_Hosp_Profee_Price 59425 Antepartum care only; 4-6 visits 59425 CDM 521 RC 59425 HCPCS facility both 1845 1845 Gross Charge Type: NIHD_RHC_Price 59426 Antepartum care only; 7 or more visits 59426 CDM 521 RC 59426 HCPCS facility both 3996 3996 Gross Charge Type: NIHD_RHC_Price 59430 Postpartum care only (separate procedure) 59430 CDM 521 RC 59430 HCPCS facility both 402 402 Gross Charge Type: NIHD_RHC_Price hydrocortisone Top 1% Crm [INYO] 5950 CDM 45802-0438-03 NDC facility both 1 EA 19.95 19.95 Gross Charge Type: Pharmacy | NDC EA = 28 APP hydrocortisone Top 1% Crm [INYO] 5950 CDM 00904-7623-31 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 28 APP "59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care" 595101 CDM 521 RC 59510 HCPCS facility both 6961 6961 Gross Charge Type: NIHD_RHC_Price "59510 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPARTUM CA ProFee" 595102 CDM 982 RC 59510 HCPCS facility both 6962 6962 Gross Charge Type: NIHD_Hosp_Profee_Price "59510 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPARTUM CA ProFee" 595102 CDM 982 RC 59510 HCPCS facility both 6962 6962 Gross Charge Type: NIHD_Hosp_Profee_Price 59514 CESAREAN DELIVERY ONLY; ProFee 59514 CDM 982 RC 59514 HCPCS facility both 3989 3989 Gross Charge Type: NIHD_Hosp_Profee_Price 59514 CESAREAN DELIVERY ONLY; ProFee 59514 CDM 982 RC 59514 HCPCS facility both 3989 3989 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR YELLOW/C-H 12MM 00595203012 5952030 CDM 278 RC facility both 7556 7556 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR YELLOW/C-H 12MM 00595203012 5952030 CDM 278 RC facility both 7556 7556 Gross Charge Type: NIHD_Hosp_Profee_Price 59525 SUBTOTAL OR TOTAL HYSTERECTOMY AFTER CESAREAN DELIVERY (LIST SEPARATELY IN ADDITION TO ProFee 59525 CDM 975 RC 59525 HCPCS facility both 800 800 Gross Charge Type: NIHD_Hosp_Profee_Price 59525 SUBTOTAL OR TOTAL HYSTERECTOMY AFTER CESAREAN DELIVERY (LIST SEPARATELY IN ADDITION TO ProFee 59525 CDM 975 RC 59525 HCPCS facility both 800 800 Gross Charge Type: NIHD_Hosp_Profee_Price hydrogen peroxide Top 3% Sol [INYO] 5954 CDM 37205-0871-34 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 237 APP hydrogen peroxide Top 3% Sol [INYO] 5954 CDM 49580-0268-06 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 237 APP tetanus immune globulin 250 units IM Sol 1 EA [INYO] 5960 CDM J1670 HCPCS 13533-0634-02 NDC facility both 1 EA 2718.78 2718.78 Gross Charge Type: Pharmacy "59612 VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT EPISIOTOMY AN ProFee" 59612 CDM 960 RC 59612 HCPCS facility both 1288 1288 Gross Charge Type: NIHD_Hosp_Profee_Price "59612 VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT EPISIOTOMY AN ProFee" 59612 CDM 960 RC 59612 HCPCS facility both 1288 1288 Gross Charge Type: NIHD_Hosp_Profee_Price propranolol 1 mg/mL IV Sol [INYO] 5981 CDM J1800 HCPCS 63323-0604-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy propranolol 1 mg/mL IV Sol [INYO] 5981 CDM J1800 HCPCS 00143-9872-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy "59812 Treatment of incomplete abortion, any trimester, completed surgically" 598121 CDM 521 RC 59812 HCPCS facility both 566 566 Gross Charge Type: NIHD_RHC_Price "59812 TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY ProFee" 598122 CDM 982 RC 59812 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price "59812 TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY ProFee" 598122 CDM 982 RC 59812 HCPCS facility both 1373 1373 Gross Charge Type: NIHD_Hosp_Profee_Price 59812 TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL TechFee 598123 CDM 450 RC facility both 5860 5860 Gross Charge Type: NIHD_Hosp_Profee_Price 59812 TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL TechFee 598123 CDM 450 RC facility both 5860 5860 Gross Charge Type: NIHD_Hosp_Profee_Price indomethacin 25 mg Cap [INYO] 5982 CDM 51079-0190-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP indomethacin 25 mg Cap [INYO] 5982 CDM 50268-0430-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "59820 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER ProFee" 59820 CDM 982 RC 59820 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "59820 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER ProFee" 59820 CDM 982 RC 59820 HCPCS facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price "59821 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER ProFee" 59821 CDM 982 RC 59821 HCPCS facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price "59821 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER ProFee" 59821 CDM 982 RC 59821 HCPCS facility both 712 712 Gross Charge Type: NIHD_Hosp_Profee_Price "59830 TREATMENT OF SEPTIC ABORTION, COMPLETED SURGICALLY ProFee" 59830 CDM 975 RC 59830 HCPCS facility both 785 785 Gross Charge Type: NIHD_Hosp_Profee_Price "59830 TREATMENT OF SEPTIC ABORTION, COMPLETED SURGICALLY ProFee" 59830 CDM 975 RC 59830 HCPCS facility both 785 785 Gross Charge Type: NIHD_Hosp_Profee_Price "59840 Induced abortion, by dilation and curettage" 59840 CDM 521 RC 59840 HCPCS facility both 1777 1777 Gross Charge Type: NIHD_RHC_Price indomethacin 50 mg Supp [INYO] 5985 CDM 42211-0102-43 NDC facility both 1 EA 816 816 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP "59855 INDUCED ABORTION, BY 1 OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH OR WITHO ProFee" 59855 CDM 982 RC 59855 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price "59855 INDUCED ABORTION, BY 1 OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH OR WITHO ProFee" 59855 CDM 982 RC 59855 HCPCS facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price DOPamine 1.6 mg/mL-D5W intravenous solution [INYO] 5986 CDM J1265 HCPCS 00409-7809-22 NDC facility both 250 ML 265 265 Gross Charge Type: Pharmacy DOPamine 1.6 mg/mL-D5W intravenous solution [INYO] 5986 CDM J1265 HCPCS 00338-1007-02 NDC facility both 250 ML 265 265 Gross Charge Type: Pharmacy dorzolamide Ophth 2% Sol [INYO] 5990 CDM 61314-0019-10 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS ipratropium CFC free 17 mcg/inh Inh Aer [INYO] 5995 CDM 00597-0087-17 NDC facility both 1 EA 1974.68 1974.68 Gross Charge Type: Pharmacy | NDC EA = 12.9 INH ipratropium 500 mcg/2.5 mL Sol [inyo] 5996 CDM J7644 HCPCS 76204-0100-01 NDC facility both 2.5 ML 36 36 Gross Charge Type: Pharmacy ipratropium 0.02% Inh Sol 2.5 mL [INYO] 5996 CDM J7644 HCPCS 00487-9801-01 NDC facility both 2.5 ML 36 36 Gross Charge Type: Pharmacy "ComfortGlide Lateral Inflatable Sheet, Standard, Blended, 40"" x 80""" 6004110 CDM 271 RC facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price "ComfortGlide Lateral Inflatable Sheet, Standard, Blended, 40"" x 80""" 6004110 CDM 271 RC facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price ACE WRAP COBAN 3 6008035 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ACE WRAP COBAN 3 6008035 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ACE WRAP 3 6008055 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ACE WRAP 3 6008055 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STERI STRIP 1/4 X 3 (EA) 6008170 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STERI STRIP 1/4 X 3 (EA) 6008170 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STERI STRIP 1/4 X 4 6008175 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STERI STRIP 1/4 X 4 6008175 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STERI STRIP 1/8 X 3 (EA) 6008185 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STERI STRIP 1/8 X 3 (EA) 6008185 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTIC DRESSING 3X8 (36EA) 6008195 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTIC DRESSING 3X8 (36EA) 6008195 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "BIOPATCH DRESSING 1""X4MM" 6008197 CDM 272 RC facility both 173 173 Gross Charge Type: NIHD_Hosp_Profee_Price "BIOPATCH DRESSING 1""X4MM" 6008197 CDM 272 RC facility both 173 173 Gross Charge Type: NIHD_Hosp_Profee_Price SILVASORB GEL 1.5 OZ 6009704 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SILVASORB GEL 1.5 OZ 6009704 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR DOME/SCREW HOLE PLUG 00875700001 6010259 CDM 278 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR DOME/SCREW HOLE PLUG 00875700001 6010259 CDM 278 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF G RIGHT 6010556 CDM facility both 21918 21918 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF G RIGHT 6010556 CDM facility both 21918 21918 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X14MM 6010557C CDM facility both 388 388 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X14MM 6010557C CDM facility both 388 388 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG V.A.C WHITE FOAM SMALL 6010564 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG V.A.C WHITE FOAM SMALL 6010564 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE II 6010567 CDM facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE II 6010567 CDM facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 12 EXT NECK 6010568 CDM facility both 24376 24376 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 12 EXT NECK 6010568 CDM facility both 24376 24376 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 10 6010580 CDM facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 10 6010580 CDM facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price PACKING GAUZE PLAIN 1/2 6010589 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price PACKING GAUZE PLAIN 1/2 6010589 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX F LEFT 6010610 CDM facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX F LEFT 6010610 CDM facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF G- LEFT 6010611 CDM facility both 21918 21918 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF G- LEFT 6010611 CDM facility both 21918 21918 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X40MM 6010612 CDM facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X40MM 6010612 CDM facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX D RIGHT 00595001402 6010613 CDM 278 RC facility both 21678 21678 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX D RIGHT 00595001402 6010613 CDM 278 RC facility both 21678 21678 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER ELEV 36MM SIZE HH VIVACIT-E 6010614 CDM facility both 8057 8057 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER ELEV 36MM SIZE HH VIVACIT-E 6010614 CDM facility both 8057 8057 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE KK VIVACIT-E 00885101236 6010616 CDM 278 RC facility both 9976 9976 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE KK VIVACIT-E 00885101236 6010616 CDM 278 RC facility both 9976 9976 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 11 6010619 CDM facility both 23930 23930 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 11 6010619 CDM facility both 23930 23930 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE LL VIVACIT-E 6010620 CDM facility both 9592 9592 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE LL VIVACIT-E 6010620 CDM facility both 9592 9592 Gross Charge Type: NIHD_Hosp_Profee_Price NASAL TAMPON SM 5.5CM 6010624 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price NASAL TAMPON SM 5.5CM 6010624 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price NASAL TAMPON LG 8.0CM 6010625 CDM facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price NASAL TAMPON LG 8.0CM 6010625 CDM facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price EPISTAT CATH / NO SYRINGE 6010626 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price EPISTAT CATH / NO SYRINGE 6010626 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR DOME/SCREW HOLE PLUG 00875700002 6010629 CDM 278 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR DOME/SCREW HOLE PLUG 00875700002 6010629 CDM 278 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 32MM SIZE GG 6010630 CDM facility both 5548 5548 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 32MM SIZE GG 6010630 CDM facility both 5548 5548 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 32MM SIZE HH 6010631 CDM facility both 5548 5548 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 32MM SIZE HH 6010631 CDM facility both 5548 5548 Gross Charge Type: NIHD_Hosp_Profee_Price ALOE VESTA PROTECTIVE OINTMENT 6010671 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ALOE VESTA PROTECTIVE OINTMENT 6010671 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING LYOFOAM 8 X 4 6010686 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING LYOFOAM 8 X 4 6010686 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE KK 6010687 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE KK 6010687 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM XTHIN 2X4 6010689 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM XTHIN 2X4 6010689 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM XTHIN 4 X 4 6010690 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM XTHIN 4 X 4 6010690 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM CGF 4X4 6010691 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM CGF 4X4 6010691 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM CGF 6X6 6010692 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM CGF 6X6 6010692 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM BORDER TRIANGLE 4X5 6010694 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM BORDER TRIANGLE 4X5 6010694 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM BORDER TRIANGLE 6X7 6010695 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM BORDER TRIANGLE 6X7 6010695 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price AQUACEL FOAM DRESSING NON-ADHESIVE 6X6 6010696 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price AQUACEL FOAM DRESSING NON-ADHESIVE 6X6 6010696 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE MM 6010701 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE MM 6010701 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price AQUACEL EXTRA 4X5 6010702 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price AQUACEL EXTRA 4X5 6010702 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG SILVASORB 4X4 6010713 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG SILVASORB 4X4 6010713 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM XTHIN 6X6 6010714 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM XTHIN 6X6 6010714 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE OO 6010715 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE OO 6010715 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price PLAIN ROPE 6010718 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price PLAIN ROPE 6010718 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG WOUND VAC LARGE 6010721 CDM 272 RC facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG WOUND VAC LARGE 6010721 CDM 272 RC facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG WOUND VAC MEDIUM 6010723 CDM 272 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG WOUND VAC MEDIUM 6010723 CDM 272 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 32MM SIZE GG 6010726 CDM facility both 5548 5548 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 32MM SIZE GG 6010726 CDM facility both 5548 5548 Gross Charge Type: NIHD_Hosp_Profee_Price WOUND VAC T.R.A.C. PAD 6010727 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price WOUND VAC T.R.A.C. PAD 6010727 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE PP 6010729 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE PP 6010729 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE QU 6010730 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE QU 6010730 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 32MM SIZE HH 6010731 CDM facility both 9822 9822 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 32MM SIZE HH 6010731 CDM facility both 9822 9822 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE MM 6010733 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE MM 6010733 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE OO 6010734 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE OO 6010734 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE PP 6010736 CDM 278 RC facility both 7613 7613 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE PP 6010736 CDM 278 RC facility both 7613 7613 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE QU 6010737 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE QU 6010737 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price NECK MODULAR KINECTIV SIZE B 6010738 CDM 278 RC facility both 6678 6678 Gross Charge Type: NIHD_Hosp_Profee_Price NECK MODULAR KINECTIV SIZE B 6010738 CDM 278 RC facility both 6678 6678 Gross Charge Type: NIHD_Hosp_Profee_Price NECK MODULAR KINECTIV SIZE E 6010744 CDM 278 RC facility both 6678 6678 Gross Charge Type: NIHD_Hosp_Profee_Price NECK MODULAR KINECTIV SIZE E 6010744 CDM 278 RC facility both 6678 6678 Gross Charge Type: NIHD_Hosp_Profee_Price NECK MODULAR KINECTIV SIZE S 6010747 CDM 278 RC facility both 6678 6678 Gross Charge Type: NIHD_Hosp_Profee_Price NECK MODULAR KINECTIV SIZE S 6010747 CDM 278 RC facility both 6678 6678 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 17.5 6010751 CDM 278 RC facility both 22997 22997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 17.5 6010751 CDM 278 RC facility both 22997 22997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 16.25 6010752 CDM 278 RC facility both 22997 22997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 16.25 6010752 CDM 278 RC facility both 22997 22997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 15 6010753 CDM 278 RC facility both 22997 22997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 15 6010753 CDM 278 RC facility both 22997 22997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 13.5 6010754 CDM 278 RC facility both 22997 22997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 13.5 6010754 CDM 278 RC facility both 22997 22997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX C LEFT 6010755 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX C LEFT 6010755 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX D- LEFT 6010757 CDM 278 RC facility both 23747 23747 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX D- LEFT 6010757 CDM 278 RC facility both 23747 23747 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX G- LEFT 6010759 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX G- LEFT 6010759 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX C RIGHT 6010760 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX C RIGHT 6010760 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX D- RIGHT 6010761 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX D- RIGHT 6010761 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX E- RIGHT 005950-015-02 6010762 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX E- RIGHT 005950-015-02 6010762 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR BLUE/C-H 12MM 6010763 CDM 278 RC facility both 7058 7058 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR BLUE/C-H 12MM 6010763 CDM 278 RC facility both 7058 7058 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR GREEN/C-H 14MM 6010767 CDM 278 RC facility both 7556 7556 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR GREEN/C-H 14MM 6010767 CDM 278 RC facility both 7556 7556 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR YELLOW/C-H 12MM 00597603012 6010772 CDM 278 RC facility both 5878 5878 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR YELLOW/C-H 12MM 00597603012 6010772 CDM 278 RC facility both 5878 5878 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 41MM DIAMETER 6010776 CDM 278 RC facility both 4786 4786 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 41MM DIAMETER 6010776 CDM 278 RC facility both 4786 4786 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 29MM W/PILOT HOLE 6010777 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 29MM W/PILOT HOLE 6010777 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 32MM W/PILOT HOLE 6010778 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 32MM W/PILOT HOLE 6010778 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 35MM W/PILOT HOLE 6010779 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 35MM W/PILOT HOLE 6010779 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 38MM W/PILOT HOLE 6010780 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 38MM W/PILOT HOLE 6010780 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PT DRESSING POLYMEM 4X4 6010827 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price PT DRESSING POLYMEM 4X4 6010827 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM SIGNAL 5 1/2 X 5 1/2 6010833 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM SIGNAL 5 1/2 X 5 1/2 6010833 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price MAXORB ROPE 6010835 CDM 272 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price MAXORB ROPE 6010835 CDM 272 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM SIGNAL 7.5X7.8 6010837 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM SIGNAL 7.5X7.8 6010837 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM SIGNAL8X9 6010838 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM SIGNAL8X9 6010838 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 18.0 3 PIECE 6014201 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 18.0 3 PIECE 6014201 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price MICRO PEELAWAY INTRO 6.5 CPLVN 6015004 CDM 272 RC facility both 259 259 Gross Charge Type: NIHD_Hosp_Profee_Price MICRO PEELAWAY INTRO 6.5 CPLVN 6015004 CDM 272 RC facility both 259 259 Gross Charge Type: NIHD_Hosp_Profee_Price MICROPUNCTURE PEELAWAY INTRO 8.5 6015007 CDM 272 RC facility both 259 259 Gross Charge Type: NIHD_Hosp_Profee_Price MICROPUNCTURE PEELAWAY INTRO 8.5 6015007 CDM 272 RC facility both 259 259 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE .035X40 J(MIN 5) 6015019 CDM 272 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE .035X40 J(MIN 5) 6015019 CDM 272 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE .025X145 J 6015021 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE .025X145 J 6015021 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE .025X40 J 6015022 CDM 272 RC facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE .025X40 J 6015022 CDM 272 RC facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE .021X30 J 6015024 CDM 272 RC facility both 86 86 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE .021X30 J 6015024 CDM 272 RC facility both 86 86 Gross Charge Type: NIHD_Hosp_Profee_Price THORA/PERICARDIOCENTESIS SET 6015032 CDM 272 RC facility both 299 299 Gross Charge Type: NIHD_Hosp_Profee_Price THORA/PERICARDIOCENTESIS SET 6015032 CDM 272 RC facility both 299 299 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER SWAN GANZ PEDS 6015043 CDM facility both 594 594 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER SWAN GANZ PEDS 6015043 CDM facility both 594 594 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER TRIPLE J PIG RSC 20CM 6015046 CDM 278 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER TRIPLE J PIG RSC 20CM 6015046 CDM 278 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price GROSHONG SINGLE LUMEN 8FR 6015060 CDM 272 RC facility both 2465 2465 Gross Charge Type: NIHD_Hosp_Profee_Price GROSHONG SINGLE LUMEN 8FR 6015060 CDM 272 RC facility both 2465 2465 Gross Charge Type: NIHD_Hosp_Profee_Price Femoral Artery Cath 20 G x 4 ½ in 6015069 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Femoral Artery Cath 20 G x 4 ½ in 6015069 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATH ARROW RADIAL ARTERY 22GAX1 3/8 6015072 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH ARROW RADIAL ARTERY 22GAX1 3/8 6015072 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price INTRODUCER SET PERFORMER 8FR 6015080 CDM 272 RC facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price INTRODUCER SET PERFORMER 8FR 6015080 CDM 272 RC facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRIPLE LUMEN STRAIGHT 20CM 6015135 CDM 272 RC facility both 477 477 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRIPLE LUMEN STRAIGHT 20CM 6015135 CDM 272 RC facility both 477 477 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE GUIDE .035X40 DBL J 6015140 CDM 272 RC facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE GUIDE .035X40 DBL J 6015140 CDM 272 RC facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price INTRODUCER COOK ACSESS PLUS 5.0 6015144 CDM 272 RC facility both 303 303 Gross Charge Type: NIHD_Hosp_Profee_Price INTRODUCER COOK ACSESS PLUS 5.0 6015144 CDM 272 RC facility both 303 303 Gross Charge Type: NIHD_Hosp_Profee_Price INTRODUCER COOK ACCESS PLUS 6.0 6015145 CDM 272 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price INTRODUCER COOK ACCESS PLUS 6.0 6015145 CDM 272 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price PRESSURE MONITORING KIT SINGLE 6016563 CDM 272 RC facility both 210 210 Gross Charge Type: NIHD_Hosp_Profee_Price PRESSURE MONITORING KIT SINGLE 6016563 CDM 272 RC facility both 210 210 Gross Charge Type: NIHD_Hosp_Profee_Price PRESSURE MONITORING KIT DOUBLE 6016567 CDM 272 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price PRESSURE MONITORING KIT DOUBLE 6016567 CDM 272 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price CRUTCH ALUMINUM YOUTH 6018005 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CRUTCH ALUMINUM YOUTH 6018005 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CRUTCH ALUMINUM ADULT TALL 6018015 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CRUTCH ALUMINUM ADULT TALL 6018015 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CRUTCH ALUMINUM ADULT ADJ MED 6018101 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CRUTCH ALUMINUM ADULT ADJ MED 6018101 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price metFORMIN 500 mg Tab [INYO] 6020 CDM 00904-7162-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metFORMIN 500 mg Tab [INYO] 6020 CDM 00904-6689-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metFORMIN 500 mg Tab [INYO] 6020 CDM 00904-6326-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "60210 PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY ProFee" 60210 CDM 982 RC 60210 HCPCS facility both 1473 1473 Gross Charge Type: NIHD_Hosp_Profee_Price "60210 PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY ProFee" 60210 CDM 982 RC 60210 HCPCS facility both 1473 1473 Gross Charge Type: NIHD_Hosp_Profee_Price BARD WOVEN FOLLOWER CATH 12 FR 6021512 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price BARD WOVEN FOLLOWER CATH 12 FR 6021512 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price BARD WOVEN FOLLOWER CATH 16 FR 6021516 CDM 272 RC facility both 154 154 Gross Charge Type: NIHD_Hosp_Profee_Price BARD WOVEN FOLLOWER CATH 16 FR 6021516 CDM 272 RC facility both 154 154 Gross Charge Type: NIHD_Hosp_Profee_Price BARD WOVEN FOLLOWER CATH 20 FR 6021520 CDM 272 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price BARD WOVEN FOLLOWER CATH 20 FR 6021520 CDM 272 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price metFORMIN 850 mg Tab [INYO] 6022 CDM 00087-6070-05 NDC facility both 1 EA 12.08 12.08 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "60220 TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY ProFee" 60220 CDM 982 RC 60220 HCPCS facility both 2124 2124 Gross Charge Type: NIHD_Hosp_Profee_Price "60220 TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY ProFee" 60220 CDM 982 RC 60220 HCPCS facility both 2124 2124 Gross Charge Type: NIHD_Hosp_Profee_Price amiodarone 200 mg Tab [INYO] 6024 CDM 00904-6556-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amiodarone 200 mg Tab [INYO] 6024 CDM 00904-6993-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amiodarone 200 mg Tab [INYO] 6024 CDM 63739-0387-10 NDC facility both 1 EA 20.28 20.28 Gross Charge Type: Pharmacy | NDC EA = 1 TAB GRIPPER NEEDLE 22 X 1 6033000 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price GRIPPER NEEDLE 22 X 1 6033000 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SPINAL 18 X 3 1/2 6033010 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SPINAL 18 X 3 1/2 6033010 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SPINAL 20 X 3 1/2 6033015 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SPINAL 20 X 3 1/2 6033015 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "cephalexin, 250 mg charge" 6034 CDM 637 RC facility both 7 7 Gross Charge Type: NIHD_RHC_Price "cephalexin, 250 mg charge" 6034 CDM 637 RC facility both 7 7 Gross Charge Type: NIHD_Clinic_Price cephalexin 500 mg Cap [INYO] 6034 CDM 00904-7337-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP cephalexin 500 mg Cap [INYO] 6034 CDM 50268-0152-15 NDC facility both 1 EA 7.33 7.33 Gross Charge Type: Pharmacy | NDC EA = 1 CAP cephalexin 500 mg Cap [INYO] 6034 CDM 60687-0163-01 NDC facility both 1 EA 8.11 8.11 Gross Charge Type: Pharmacy | NDC EA = 1 CAP SPLINT FINGER STAX SIZE 5 6034000 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT FINGER STAX SIZE 5 6034000 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price FOAM ABDUCTOR BRACE 6X12X22 6034M60076L 6034076 CDM 271 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price FOAM ABDUCTOR BRACE 6X12X22 6034M60076L 6034076 CDM 271 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Doxycycline 100mg #14 caps 6035 CDM 637 RC facility both 7 7 Gross Charge Type: NIHD_RHC_Price Doxycycline 100mg #14 caps 6035 CDM 637 RC facility both 7 7 Gross Charge Type: NIHD_Clinic_Price fentaNYL 75 mcg/hr Transderm ER Film [INYO] 6035 CDM 00406-9075-76 NDC facility both 1 EA 201.05 201.05 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES OB DELIVERY PACK 6035025 CDM 272 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price OB DELIVERY PACK 6035025 CDM 272 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price TRAY AMNIOCENTESIS 6035552 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price TRAY AMNIOCENTESIS 6035552 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER UMBILICAL 3.5FR 6035560 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER UMBILICAL 3.5FR 6035560 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price NEONATAL LUMBAR PUNCT KIT 1 1/2 6035569 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price NEONATAL LUMBAR PUNCT KIT 1 1/2 6035569 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price TRAY PH PARACERV PURDEN BLOCK 6035570 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price TRAY PH PARACERV PURDEN BLOCK 6035570 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price OB SUPPLEMENTAL NURSING SYSTEM 6035571 CDM facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price OB SUPPLEMENTAL NURSING SYSTEM 6035571 CDM facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price SYMPHONY DOUBLE PUMP SYSTEM 6037005 CDM 271 RC facility both 72 72 Gross Charge Type: NIHD_Hosp_Profee_Price SYMPHONY DOUBLE PUMP SYSTEM 6037005 CDM 271 RC facility both 72 72 Gross Charge Type: NIHD_Hosp_Profee_Price BABY SHADES II (6003-1) 6037006 CDM facility both 253 253 Gross Charge Type: NIHD_Hosp_Profee_Price BABY SHADES II (6003-1) 6037006 CDM facility both 253 253 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX G LEFT 6038555 CDM 278 RC facility both 21228 21228 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX G LEFT 6038555 CDM 278 RC facility both 21228 21228 Gross Charge Type: NIHD_Hosp_Profee_Price "Patient Positioners: Abduction Pillow, Medium, 6"" x 15"" x 22""" 6038593 CDM 271 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price "Patient Positioners: Abduction Pillow, Medium, 6"" x 15"" x 22""" 6038593 CDM 271 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price TOE ALIGNMENT SPLINT 6038601 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price TOE ALIGNMENT SPLINT 6038601 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J SUPER SHORT 6038641 CDM 274 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J SUPER SHORT 6038641 CDM 274 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J SMALL 6038642 CDM 274 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J SMALL 6038642 CDM 274 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J MED 6038643 CDM 274 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J MED 6038643 CDM 274 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J LARGE 6038644 CDM 274 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J LARGE 6038644 CDM 274 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J STOUT 6038645 CDM 274 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J STOUT 6038645 CDM 274 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J EX SM 6038646 CDM 274 RC facility both 171 171 Gross Charge Type: NIHD_Hosp_Profee_Price COLLAR CERV MIAMI J EX SM 6038646 CDM 274 RC facility both 171 171 Gross Charge Type: NIHD_Hosp_Profee_Price ER BRACE GALVESTON SMALL 6038650 CDM 274 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price ER BRACE GALVESTON SMALL 6038650 CDM 274 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price ER BRACE GALVESTON MED 6038651 CDM 274 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price ER BRACE GALVESTON MED 6038651 CDM 274 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price ER BRACE GALVESTON METACARPAL LG 6038652 CDM 274 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price ER BRACE GALVESTON METACARPAL LG 6038652 CDM 274 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price ER BRACE GALVESTON METACARPAL XL 6038653 CDM 274 RC facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price ER BRACE GALVESTON METACARPAL XL 6038653 CDM 274 RC facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price ER SPLINT SAM ORANGE 6038660 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ER SPLINT SAM ORANGE 6038660 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER MED RT 6038677 CDM 271 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER MED RT 6038677 CDM 271 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER LRG RT 6038678 CDM 271 RC facility both 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER LRG RT 6038678 CDM 271 RC facility both 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER SM LFT 6038679 CDM 271 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER SM LFT 6038679 CDM 271 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER MED LFT 6038680 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER MED LFT 6038680 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER LRG LFT 6038681 CDM 271 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price ER THUMB KEEPER LRG LFT 6038681 CDM 271 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price WRIST RT XS 6038730 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price WRIST RT XS 6038730 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price WRIST RT XS 6038730 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price WRIST RT XS 6038730 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT RT SM 6038735 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price 10 DELUXE WRIST SPLINT RT SM 6038735 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price 10 DELUXE WRIST SPLINT RT SM 6038735 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT RT SM 6038735 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT RT MED 6038740 CDM 274 RC L3908 HCPCS facility both 19 19 Gross Charge Type: NIHD_RHC_Price 10 DELUXE WRIST SPLINT RT MED 6038740 CDM 274 RC L3908 HCPCS facility both 19 19 Gross Charge Type: NIHD_Clinic_Price 10 DELUXE WRIST SPLINT RT MED 6038740 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT RT MED 6038740 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT RT LRG 6038745 CDM 274 RC L3908 HCPCS facility both 19 19 Gross Charge Type: NIHD_RHC_Price 10 DELUXE WRIST SPLINT RT LRG 6038745 CDM 274 RC L3908 HCPCS facility both 19 19 Gross Charge Type: NIHD_Clinic_Price 10 DELUXE WRIST SPLINT RT LRG 6038745 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT RT LRG 6038745 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT RT XLRG 6038750 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price 10 DELUXE WRIST SPLINT RT XLRG 6038750 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price 10 DELUXE WRIST SPLINT RT XLRG 6038750 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT RT XLRG 6038750 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT LT XS 6038755 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price 10 DELUXE WRIST SPLINT LT XS 6038755 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price 10 DELUXE WRIST SPLINT LT XS 6038755 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT LT XS 6038755 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT LT SM 6038760 CDM 274 RC L3908 HCPCS facility both 19 19 Gross Charge Type: NIHD_RHC_Price 10 DELUXE WRIST SPLINT LT SM 6038760 CDM 274 RC L3908 HCPCS facility both 19 19 Gross Charge Type: NIHD_Clinic_Price 10 DELUXE WRIST SPLINT LT SM 6038760 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT LT SM 6038760 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price WRIST SPLINT LFT UNIVERSAL 6038765 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price WRIST SPLINT LFT UNIVERSAL 6038765 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price WRIST SPLINT LFT UNIVERSAL 6038765 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price WRIST SPLINT LFT UNIVERSAL 6038765 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT LT LRG 6038770 CDM 274 RC L3908 HCPCS facility both 19 19 Gross Charge Type: NIHD_RHC_Price 10 DELUXE WRIST SPLINT LT LRG 6038770 CDM 274 RC L3908 HCPCS facility both 19 19 Gross Charge Type: NIHD_Clinic_Price 10 DELUXE WRIST SPLINT LT LRG 6038770 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT LT LRG 6038770 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT LT XL 6038775 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price 10 DELUXE WRIST SPLINT LT XL 6038775 CDM 274 RC L3908 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price 10 DELUXE WRIST SPLINT LT XL 6038775 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 10 DELUXE WRIST SPLINT LT XL 6038775 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ER SPLINT SAM JUNIOR GRY 6038780 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ER SPLINT SAM JUNIOR GRY 6038780 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ER SPLINT SAM REGULAR GRAY 6038782 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ER SPLINT SAM REGULAR GRAY 6038782 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ER SPLINT SAM FINGER 6038784 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ER SPLINT SAM FINGER 6038784 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price WALKING CAM BRACE SM 6039001 CDM 274 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price WALKING CAM BRACE SM 6039001 CDM 274 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price WALKING CAM BRACE MED 6039002 CDM 274 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price WALKING CAM BRACE MED 6039002 CDM 274 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price WALKING CAM BRACE LRG 6039003 CDM 274 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price WALKING CAM BRACE LRG 6039003 CDM 274 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price RIB BELT FEMALE 6039010 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RIB BELT FEMALE 6039010 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RIB BELT XL LONG 6039014 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RIB BELT XL LONG 6039014 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RIB BELT MALE 6039015 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RIB BELT MALE 6039015 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RIB BELT MALE 8 WIDE 6039016 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RIB BELT MALE 8 WIDE 6039016 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNIV XSM 6039017 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNIV XSM 6039017 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATTELLA UNIV SM 6039018 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATTELLA UNIV SM 6039018 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNIV MED 6039019 CDM 274 RC L1812 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price KNEE PATELLA UNIV MED 6039019 CDM 274 RC L1812 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price KNEE PATELLA UNIV MED 6039019 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNIV MED 6039019 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNIV LRG 6039020 CDM 274 RC L1812 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price KNEE PATELLA UNIV LRG 6039020 CDM 274 RC L1812 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price KNEE PATELLA UNIV LRG 6039020 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNIV LRG 6039020 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNV XLRG 6039021 CDM 274 RC L1812 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price KNEE PATELLA UNV XLRG 6039021 CDM 274 RC L1812 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price KNEE PATELLA UNV XLRG 6039021 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNV XLRG 6039021 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNV XXLRG 6039022 CDM 274 RC L1812 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price KNEE PATELLA UNV XXLRG 6039022 CDM 274 RC L1812 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price KNEE PATELLA UNV XXLRG 6039022 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE PATELLA UNV XXLRG 6039022 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price AIRCAST ANKLE LEFT 6039050 CDM 274 RC L4350 HCPCS facility both 51 51 Gross Charge Type: NIHD_RHC_Price AIRCAST ANKLE LEFT 6039050 CDM 274 RC L4350 HCPCS facility both 51 51 Gross Charge Type: NIHD_Clinic_Price AIRCAST ANKLE LEFT 6039050 CDM 274 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price AIRCAST ANKLE LEFT 6039050 CDM 274 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price BREG BRACE LONG MED 6039053 CDM 274 RC L1833 HCPCS facility both 194 194 Gross Charge Type: NIHD_RHC_Price BREG BRACE LONG MED 6039053 CDM 274 RC L1833 HCPCS facility both 194 194 Gross Charge Type: NIHD_Clinic_Price BREG BRACE LONG MED 6039053 CDM 274 RC facility both 194 194 Gross Charge Type: NIHD_Hosp_Profee_Price BREG BRACE LONG MED 6039053 CDM 274 RC facility both 194 194 Gross Charge Type: NIHD_Hosp_Profee_Price BREG BRACE LONG LRG 6039054 CDM 274 RC L1833 HCPCS facility both 200 200 Gross Charge Type: NIHD_RHC_Price BREG BRACE LONG LRG 6039054 CDM 274 RC L1833 HCPCS facility both 200 200 Gross Charge Type: NIHD_Clinic_Price BREG BRACE LONG LRG 6039054 CDM 274 RC facility both 200 200 Gross Charge Type: NIHD_Hosp_Profee_Price BREG BRACE LONG LRG 6039054 CDM 274 RC facility both 200 200 Gross Charge Type: NIHD_Hosp_Profee_Price AIRCAST ANKLE RIGHT 6039055 CDM 274 RC L4350 HCPCS facility both 51 51 Gross Charge Type: NIHD_RHC_Price AIRCAST ANKLE RIGHT 6039055 CDM 274 RC L4350 HCPCS facility both 51 51 Gross Charge Type: NIHD_Clinic_Price AIRCAST ANKLE RIGHT 6039055 CDM 274 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price AIRCAST ANKLE RIGHT 6039055 CDM 274 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price BREG BRACE SHORT MED 6039056 CDM 274 RC L1833 HCPCS facility both 194 194 Gross Charge Type: NIHD_RHC_Price BREG BRACE SHORT MED 6039056 CDM 274 RC L1833 HCPCS facility both 194 194 Gross Charge Type: NIHD_Clinic_Price BREG BRACE SHORT MED 6039056 CDM 274 RC facility both 194 194 Gross Charge Type: NIHD_Hosp_Profee_Price BREG BRACE SHORT MED 6039056 CDM 274 RC facility both 194 194 Gross Charge Type: NIHD_Hosp_Profee_Price BREG BRACE SHORT LRG 6039057 CDM 274 RC L1833 HCPCS facility both 760 760 Gross Charge Type: NIHD_RHC_Price BREG BRACE SHORT LRG 6039057 CDM 274 RC L1833 HCPCS facility both 760 760 Gross Charge Type: NIHD_Clinic_Price BREG BRACE SHORT LRG 6039057 CDM 274 RC facility both 760 760 Gross Charge Type: NIHD_Hosp_Profee_Price BREG BRACE SHORT LRG 6039057 CDM 274 RC facility both 760 760 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL XL 22 LONG X 22-26 CIRCUMFE 6039060 CDM 274 RC L1830 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price KNEE IMMOBIL XL 22 LONG X 22-26 CIRCUMFE 6039060 CDM 274 RC L1830 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price KNEE IMMOBIL XL 22 LONG X 22-26 CIRCUMFE 6039060 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL XL 22 LONG X 22-26 CIRCUMFE 6039060 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL LG 22 LONG X 19-22 CIRCUMFE 6039065 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL LG 22 LONG X 19-22 CIRCUMFE 6039065 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL LG 20 LONG X 19-22 CIRCUMFE 6039067 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL LG 20 LONG X 19-22 CIRCUMFE 6039067 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL MD 20 LONG X 16-19 CIRCUMFE 6039068 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL MD 20 LONG X 16-19 CIRCUMFE 6039068 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL MD 16 LONG X 16-19 CIRCUMFE 6039069 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL MD 16 LONG X 16-19 CIRCUMFE 6039069 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price AIRCAST LEG LEFT 6039070 CDM 274 RC L4350 HCPCS facility both 115 115 Gross Charge Type: NIHD_RHC_Price AIRCAST LEG LEFT 6039070 CDM 274 RC L4350 HCPCS facility both 115 115 Gross Charge Type: NIHD_Clinic_Price AIRCAST LEG LEFT 6039070 CDM 274 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price AIRCAST LEG LEFT 6039070 CDM 274 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL SM 16 LONG X 14-16 CIRCUMFE 6039071 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL SM 16 LONG X 14-16 CIRCUMFE 6039071 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL SM 12 LONG X 14-16 CIRCUMFE 6039072 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE IMMOBIL SM 12 LONG X 14-16 CIRCUMFE 6039072 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price AIRCAST LEG RIGHT 6039075 CDM 274 RC L4350 HCPCS facility both 115 115 Gross Charge Type: NIHD_RHC_Price AIRCAST LEG RIGHT 6039075 CDM 274 RC L4350 HCPCS facility both 115 115 Gross Charge Type: NIHD_Clinic_Price AIRCAST LEG RIGHT 6039075 CDM 274 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price AIRCAST LEG RIGHT 6039075 CDM 274 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR LRG 6039080 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR LRG 6039080 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "EXTRICATION COLLAR, STIFNECK SELECT ADUL" 6039082 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price "EXTRICATION COLLAR, STIFNECK SELECT ADUL" 6039082 CDM 274 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR MED 6039085 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR MED 6039085 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price AMBU PERFIT ADJ C-COLLAR ADULT 6039086 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price AMBU PERFIT ADJ C-COLLAR ADULT 6039086 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR MED - LONG 6039090 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR MED - LONG 6039090 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR SMALL 6039100 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR SMALL 6039100 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR X-LRG 6039105 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CERVICAL COLLAR X-LRG 6039105 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER IMMOBILIZER XLRG 6039120 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER IMMOBILIZER XLRG 6039120 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER IMMOBILIZER LARGE 6039125 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER IMMOBILIZER LARGE 6039125 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER IMMOBILIZER MED 6039130 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER IMMOBILIZER MED 6039130 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER IMMOBILIZER SM 6039135 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER IMMOBILIZER SM 6039135 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP MENS X LRG 6039139 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP MENS X LRG 6039139 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP LRG 6039140 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP LRG 6039140 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP MED 6039145 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP MED 6039145 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP SMALL 6039150 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP SMALL 6039150 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP WOMENS MED 6039160 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP WOMENS MED 6039160 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP FEMALE SMALL 6039165 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SHOE POST OP FEMALE SMALL 6039165 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SLING & SWATHE UNIVERSAL 6039180 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SLING & SWATHE UNIVERSAL 6039180 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING LRG 6039190 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING LRG 6039190 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING XLRG 6039193 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING XLRG 6039193 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING MED 6039195 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING MED 6039195 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING SM 6039200 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING SM 6039200 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING BEAR CHILD 6039201 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ARM SLING BEAR CHILD 6039201 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT X LARGE 6039205 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT X LARGE 6039205 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT PAD LARGE 6039210 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT PAD LARGE 6039210 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT MED 6039213 CDM 274 RC L3650 HCPCS facility both 19 19 Gross Charge Type: NIHD_RHC_Price CLAVICLE SPLINT MED 6039213 CDM 274 RC L3650 HCPCS facility both 19 19 Gross Charge Type: NIHD_Clinic_Price CLAVICLE SPLINT MED 6039213 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT MED 6039213 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT SM 6039220 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT SM 6039220 CDM 274 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT X SMALL 6039225 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CLAVICLE SPLINT X SMALL 6039225 CDM 274 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BUCKS TRACTION MED 6039227 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BUCKS TRACTION MED 6039227 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price Do not order per Justin 4/6/2022 6039228 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price Do not order per Justin 4/6/2022 6039228 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BUCKS TRACTION SM 6039229 CDM facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price BUCKS TRACTION SM 6039229 CDM facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price ABDOMINAL SUPPORT UNIVERSAL 6039230 CDM 272 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price ABDOMINAL SUPPORT UNIVERSAL 6039230 CDM 272 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT 1/2X9 (12EA) 6039419 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT 1/2X9 (12EA) 6039419 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT 1X18 (6EA) 6039425 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT 1X18 (6EA) 6039425 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ICE PACK PERSONAL 6045005 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ICE PACK PERSONAL 6045005 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ketorolac 10 mg Tab [INYO] 6051 CDM 00093-0314-01 NDC facility both 1 EA 12.94 12.94 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ketoconazole 200 mg Tab [INYO] 6052 CDM 00093-0900-01 NDC facility both 1 EA 37.55 37.55 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ketoconazole 200 mg Tab [INYO] 6052 CDM 35573-0433-30 NDC facility both 1 EA 22.74 22.74 Gross Charge Type: Pharmacy | NDC EA = 1 TAB OSTOMY POUCH CLEAR 2 1/4 6052014 CDM 270 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price OSTOMY POUCH CLEAR 2 1/4 6052014 CDM 270 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price OSTOMY POUCH CLEAR 4 6052015 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price OSTOMY POUCH CLEAR 4 6052015 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price OSTOMY POUCH NATURAL 1 1/4 6052018 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price OSTOMY POUCH NATURAL 1 1/4 6052018 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STOMAHESIVE POWDER 6052027 CDM 271 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price STOMAHESIVE POWDER 6052027 CDM 271 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price "OSTOMY POUCH CLEAR 1 3/4""" 6052113 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "OSTOMY POUCH CLEAR 1 3/4""" 6052113 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE NEONATAL 3.0 NEO 6053013 CDM facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE NEONATAL 3.0 NEO 6053013 CDM facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE NEONATAL 4.0 NEO 6053015 CDM 278 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE NEONATAL 4.0 NEO 6053015 CDM 278 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE PEDIATRIC 3.0 PED 6053016 CDM 272 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE PEDIATRIC 3.0 PED 6053016 CDM 272 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE PEDIATRIC 3.5 PED 6053017 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE PEDIATRIC 3.5 PED 6053017 CDM 278 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE PEDIATRIC 4.5PED 6053019 CDM 278 RC facility both 56 56 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE PEDIATRIC 4.5PED 6053019 CDM 278 RC facility both 56 56 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE ADULT 10 DCT 6053024 CDM 272 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE ADULT 10 DCT 6053024 CDM 272 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price RT/ET BITE BLOCK 6053050 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RT/ET BITE BLOCK 6053050 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH MASK ADULT 6053053 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH MASK ADULT 6053053 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CPAP WHISPER SWIVEL VALVE 6053096 CDM facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price CPAP WHISPER SWIVEL VALVE 6053096 CDM facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price RT ET TUBE 7.0MM CUFFED 6053110 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RT ET TUBE 7.0MM CUFFED 6053110 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RT ET TUBE 8.5MM CUFFED 6053113 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RT ET TUBE 8.5MM CUFFED 6053113 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price PERTRACH KIT ADULT 6053205 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price PERTRACH KIT ADULT 6053205 CDM 272 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price PERTRACH KIT PEDIATRIC 6053206 CDM 272 RC facility both 477 477 Gross Charge Type: NIHD_Hosp_Profee_Price PERTRACH KIT PEDIATRIC 6053206 CDM 272 RC facility both 477 477 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE FENESTRATED 4 CFN 6053579 CDM 278 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE FENESTRATED 4 CFN 6053579 CDM 278 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE FENESTRATED SZ 6 CFN 6053580 CDM 272 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE FENESTRATED SZ 6 CFN 6053580 CDM 272 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE FENESTRATED SZ 8 CFN 6053581 CDM 272 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH TUBE FENESTRATED SZ 8 CFN 6053581 CDM 272 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH CARE KIT 6053582 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price TRACH CARE KIT 6053582 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price RT TRACH SHILEY UNCUFFED 8 DCSF 6053611 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price RT TRACH SHILEY UNCUFFED 8 DCSF 6053611 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price RT TRACH SHILEY UNCUFFED 6 DCFS 6053612 CDM 278 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price RT TRACH SHILEY UNCUFFED 6 DCFS 6053612 CDM 278 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price IRRIGATION SYSTEM IRRIJET 6057023 CDM 272 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price IRRIGATION SYSTEM IRRIJET 6057023 CDM 272 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price REFRESH LACRI-LUBE OINTMENT [INYO] 6063 CDM 00023-0312-04 NDC facility both 1 EA 70.32 70.32 Gross Charge Type: Pharmacy | NDC EA = 3.5 APP PARACENTESIS TRAY 6063004 CDM 272 RC facility both 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price PARACENTESIS TRAY 6063004 CDM 272 RC facility both 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price lactobacillus acidophilus and bulgaricus Oral Gran [INYO] 6065 CDM 64980-0146-12 NDC facility both 1 EA 12.19 12.19 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS lactobacillus acidophilus and bulgaricus Oral Gran [INYO] 6065 CDM 08290-2367-12 NDC facility both 1 EA 8.31 8.31 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS furosemide 40 mg Tab [inyo] 6073 CDM 00904-7178-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB furosemide 40 mg Tab [INYO] 6073 CDM 00054-8299-25 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB furosemide 40 mg Tab [INYO] 6073 CDM 51079-0073-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB furosemide 40 mg Tab [INYO] 6073 CDM 00904-5797-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB THORACENTESIS SET WITH DRAIN 607327 CDM 274 RC facility both 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price THORACENTESIS SET WITH DRAIN 607327 CDM 274 RC facility both 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price furosemide 20 mg/ 2 mL Inj Sol [INYO] 6074 CDM J1940 HCPCS 36000-0282-25 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy furosemide 20 mg/ 2 mL Inj Sol [INYO] 6074 CDM J1940 HCPCS 23155-0473-41 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy furosemide 20 mg/ 2 mL Inj Sol [INYO] 6074 CDM J1940 HCPCS 00409-6102-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy LUMBAR PUCTURE TRAY ADULT 6074005 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price LUMBAR PUCTURE TRAY ADULT 6074005 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE REMOVAL KIT 0816UT309100 6074035 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE REMOVAL KIT 0816UT309100 6074035 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price THORACENTESIS TRAY W/ASPIRATION (4340A) 6075008 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price THORACENTESIS TRAY W/ASPIRATION (4340A) 6075008 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price PORTEX TRACH TUBE 3.0 6075106 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price PORTEX TRACH TUBE 3.0 6075106 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price PORTEX TRACH TUBE 3.5 6075107 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price PORTEX TRACH TUBE 3.5 6075107 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price furosemide 10 mg/mL Oral Liq [INYO] 6076 CDM 00054-3294-46 NDC facility both 60 ML 52 52 Gross Charge Type: Pharmacy TUBE MINNESOTA/ESOPH 6076558 CDM 272 RC facility both 1089 1089 Gross Charge Type: NIHD_Hosp_Profee_Price TUBE MINNESOTA/ESOPH 6076558 CDM 272 RC facility both 1089 1089 Gross Charge Type: NIHD_Hosp_Profee_Price MECONIUM ASPIRATOR 6076559 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price MECONIUM ASPIRATOR 6076559 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "CHEST TUBE/TROCAR 28 FR 15 3/4""" 6076580 CDM 272 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price "CHEST TUBE/TROCAR 28 FR 15 3/4""" 6076580 CDM 272 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/TROCAR 32 FR 6076581 CDM 272 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/TROCAR 32 FR 6076581 CDM 272 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/THORACIC 36FRX20IN 6076583 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/THORACIC 36FRX20IN 6076583 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SIMPLE PNEUMOTHORAX ASPIRATION 6076595 CDM 272 RC facility both 150 150 Gross Charge Type: NIHD_Hosp_Profee_Price SIMPLE PNEUMOTHORAX ASPIRATION 6076595 CDM 272 RC facility both 150 150 Gross Charge Type: NIHD_Hosp_Profee_Price OB THORACATH 9.6FR INFANT 6076598 CDM 272 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price OB THORACATH 9.6FR INFANT 6076598 CDM 272 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/THORACIC 16FRX20IN 6076606 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/THORACIC 16FRX20IN 6076606 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/ THORACIC 28FRX20IN 6076607 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/ THORACIC 28FRX20IN 6076607 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/THORACIC 20FRX20IN 6076608 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/THORACIC 20FRX20IN 6076608 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/ THORACIC 32FRX20IN NO TROCAR 6076611 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CHEST TUBE/ THORACIC 32FRX20IN NO TROCAR 6076611 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 10FR PEDIATRIC (LATEX) 6078001 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 10FR PEDIATRIC (LATEX) 6078001 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY PEDIATRIC 10FR 6078002 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY PEDIATRIC 10FR 6078002 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 12FRX5CC 6078003 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 12FRX5CC 6078003 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER PEDIATRIC 10FR (LATEX) 6078004 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER PEDIATRIC 10FR (LATEX) 6078004 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH HYDROGEL FOLEY SILVER 20FRX5CC 6078007 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH HYDROGEL FOLEY SILVER 20FRX5CC 6078007 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 24FRX5CC 6078009 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 24FRX5CC 6078009 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 26FRX5CC 6078010 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 26FRX5CC 6078010 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 12FR 6078018 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 12FR 6078018 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 14FR 6078019 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 14FR 6078019 CDM 272 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 18FR 6078021 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 18FR 6078021 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 20FR 6078022 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 20FR 6078022 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 22FR 6078023 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 22FR 6078023 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 24FR 6078024 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 24FR 6078024 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY 3-WAY 18FRX5CC (LATEX) 6078031 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY 3-WAY 18FRX5CC (LATEX) 6078031 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 16FR 6078090 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY COUDE 16FR 6078090 CDM 272 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY 3-WAY 16FRX30CC 6078107 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY 3-WAY 16FRX30CC 6078107 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH KIT FEMALE 8FR. 6078126 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price CATH KIT FEMALE 8FR. 6078126 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price BARTHOLIN GLAND CATHETER 6078146 CDM 272 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price BARTHOLIN GLAND CATHETER 6078146 CDM 272 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 14FRX5CC 6078148 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 14FRX5CC 6078148 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 16FRX5CC 6078150 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY SILVER 16FRX5CC 6078150 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price UNIVERSAL CATH TRAY 6081023 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price UNIVERSAL CATH TRAY 6081023 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SILVER FOLEY TRAY 16FR 6081024 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SILVER FOLEY TRAY 16FR 6081024 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SILVER FOLEY TRAY 18FR 6081025 CDM 272 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price SILVER FOLEY TRAY 18FR 6081025 CDM 272 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price SILVER FOLEY TRAY W/ URINE METER 14FR 6081028 CDM 272 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price SILVER FOLEY TRAY W/ URINE METER 14FR 6081028 CDM 272 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY FOLEY W/O CATH 907600 6081040 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY FOLEY W/O CATH 907600 6081040 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY STRAIGHT 14FR RED RUBBER 6081046 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY STRAIGHT 14FR RED RUBBER 6081046 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY IC 16FR TMP SENS W/UR METR 6081057 CDM 272 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price CATH TRAY IC 16FR TMP SENS W/UR METR 6081057 CDM 272 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price chlordiazePOXIDE 25 mg Cap [INYO] 6088 CDM 51079-0141-20 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP chlordiazePOXIDE 25 mg Cap [INYO] 6088 CDM 00555-0159-02 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP lidocaine 0.4%-D5W Inj Sol 500 mL [INYO] 6091 CDM J2001 HCPCS 00338-0409-03 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy lidocaine 5%-0.4% Sol [inyo] 6091 CDM J2001 HCPCS 00264-9594-10 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy MORGAN THERAPEUTIC LENS 6097560 CDM 278 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price MORGAN THERAPEUTIC LENS 6097560 CDM 278 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price AQUA GUARD 10 6097578 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price AQUA GUARD 10 6097578 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BRUSH BURR ALYER 1.0MM 6097579 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BRUSH BURR ALYER 1.0MM 6097579 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price IRRIGATION WOUND IRRIMAX 450ML 6097583 CDM 272 RC facility both 239 239 Gross Charge Type: NIHD_Hosp_Profee_Price IRRIGATION WOUND IRRIMAX 450ML 6097583 CDM 272 RC facility both 239 239 Gross Charge Type: NIHD_Hosp_Profee_Price SHUR-CLENS SM 6097585 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SHUR-CLENS SM 6097585 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price READYBATH SHAMPOO CONDITIONING CAPS 6097667 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price READYBATH SHAMPOO CONDITIONING CAPS 6097667 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price TOOTHETTE ORAL CARE SYSTEM 6097668 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price TOOTHETTE ORAL CARE SYSTEM 6097668 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ANTI-EMBOLI STOCKING KNEE HI LG 6098102 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ANTI-EMBOLI STOCKING KNEE HI LG 6098102 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ANTI-EMBOLI STOCKING KNEE HI MED 6098103 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ANTI-EMBOLI STOCKING KNEE HI MED 6098103 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ANTI-EMBOLI STOCKING THIGH HI LG 6098106 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ANTI-EMBOLI STOCKING THIGH HI LG 6098106 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER SKIN VISISTAT 35R 61001 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER SKIN VISISTAT 35R 61001 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price atropine-diphenoxylate 0.025 mg-2.5 mg Tab [INYO] 6106 CDM 69315-0910-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB atropine-diphenoxylate 0.025 mg-2.5 mg Tab [INYO] 6106 CDM 00378-0415-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB atropine-diphenoxylate 0.025 mg-2.5 mg Tab [INYO] 6106 CDM 60687-0569-01 NDC facility both 1 EA 6.99 6.99 Gross Charge Type: Pharmacy | NDC EA = 1 TAB edrophonium 10 mg/mL Inj Sol [INYO] 6114 CDM 67457-0190-15 NDC facility both 15 ML 768 768 Gross Charge Type: Pharmacy enalapril 10 mg Tab [INYO] 6115 CDM 23155-0772-01 NDC facility both 1 EA 11.66 11.66 Gross Charge Type: Pharmacy | NDC EA = 1 TAB enalapril 10 mg Tab [INYO] 6115 CDM 00904-5610-61 NDC facility both 1 EA 9.72 9.72 Gross Charge Type: Pharmacy | NDC EA = 1 TAB mag-al 200 mg-200 mg/5 mL Oral Susp 30 mL [INYO] 6121 CDM 00121-1760-30 NDC facility both 30 ML 21.6 21.6 Gross Charge Type: Pharmacy BARD GHIATAS LOCALIZATION WIRE 20GA 7CM 6140897 CDM facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price BARD GHIATAS LOCALIZATION WIRE 20GA 7CM 6140897 CDM facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price Biopsy Needle Maxcore 18gx25 cm 6141825 CDM 272 RC A4649 HCPCS facility both 319 319 Gross Charge Type: NIHD_RHC_Price Biopsy Needle Maxcore 18gx25 cm 6141825 CDM 272 RC A4649 HCPCS facility both 319 319 Gross Charge Type: NIHD_Clinic_Price BIOPSY NEEDLE MAXCORE 18G X 25CM 6141825 CDM 272 RC facility both 319 319 Gross Charge Type: NIHD_Hosp_Profee_Price BIOPSY NEEDLE MAXCORE 18G X 25CM 6141825 CDM 272 RC facility both 319 319 Gross Charge Type: NIHD_Hosp_Profee_Price methylPREDNISolone 4 mg Tab [INYO] 6155 CDM J7509 HCPCS 00904-6914-61 NDC facility both 1 EA 13.36 13.36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methylPREDNISolone 4 mg Tab [INYO] 6155 CDM J7509 HCPCS 00603-4593-15 NDC facility both 1 EA 8.57 8.57 Gross Charge Type: Pharmacy | NDC EA = 1 TAB thioridazine 25 mg Tab [INYO] 6161 CDM 51079-0566-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB phytonadione 5 mg Tab [INYO] 6169 CDM 00187-1704-05 NDC facility both 1 EA 282.05 282.05 Gross Charge Type: Pharmacy | NDC EA = 1 TAB phytonadione 5 mg Tab [INYO] 6169 CDM 00904-6882-10 NDC facility both 1 EA 410.83 410.83 Gross Charge Type: Pharmacy | NDC EA = 1 TAB psyllium 3.4 g/5.8 g Oral Pwdr [INYO] 6174 CDM 37000-0024-04 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS magnesium hydroxide 8% Oral Susp 30 mL [INYO] 6191 CDM 00121-0431-30 NDC facility both 30 ML 14.05 14.05 Gross Charge Type: Pharmacy DRAIN LATEX MALECOT 4WING 10FR 6200861 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_RHC_Price DRAIN LATEX MALECOT 4WING 10FR 6200861 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_Clinic_Price DRAIN LATEX MALECOT 4WING 10FR 6200861 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 10FR 6200861 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 14FR 6200864 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_RHC_Price DRAIN LATEX MALECOT 4WING 14FR 6200864 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_Clinic_Price DRAIN LATEX MALECOT 4WING 14FR 6200864 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 14FR 6200864 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price morphine 10 mg/mL preservative-free Sol [INYO] 6205 CDM J2274 HCPCS 00641-6127-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy DRAIN LATEX MALECOT 4WING 12FR 6208612 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_RHC_Price DRAIN LATEX MALECOT 4WING 12FR 6208612 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_Clinic_Price DRAIN LATEX MALECOT 4WING 12FR 6208612 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 12FR 6208612 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 16FR 6218616 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_RHC_Price DRAIN LATEX MALECOT 4WING 16FR 6218616 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_Clinic_Price DRAIN LATEX MALECOT 4WING 16FR 6218616 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 16FR 6218616 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price famotidine 20 mg Tab [INYO] 6221 CDM 00904-7193-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB famotidine 20 mg Tab [INYO] 6221 CDM 60687-0595-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB famotidine 20 mg Tab [INYO] 6221 CDM 61442-0121-01 NDC facility both 1 EA 12.46 12.46 Gross Charge Type: Pharmacy | NDC EA = 1 TAB famotidine 20 mg Tab [INYO] 6221 CDM 63739-0645-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB famotidine 20 mg Tab [INYO] 6221 CDM 00904-5780-51 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB famotidine 20 mg/2mL IV Sol [INYO] 6223 CDM J3490 HCPCS 63323-0739-12 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy famotidine 20 mg/2 mL IV Sol [INYO] 6223 CDM J3490 HCPCS 00641-6022-25 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy famotidine 10 mg/mL Sol [inyo] 6223 CDM J3490 HCPCS 70860-0751-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy famotidine 20 mg/2 mL IV Sol [INYO] 6223 CDM J3490 HCPCS 67457-0433-22 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy nystatin-triamcinolone Top Oint [INYO] 6224 CDM 51672-1272-01 NDC facility both 1 EA 447.76 447.76 Gross Charge Type: Pharmacy | NDC EA = 15 APP nystatin-triamcinolone Top Crm [INYO] 6225 CDM 51672-1263-01 NDC facility both 1 EA 447.76 447.76 Gross Charge Type: Pharmacy | NDC EA = 15 APP nystatin-triamcinolone Top Crm [INYO] 6225 CDM 68462-0314-17 NDC facility both 1 EA 447.76 447.76 Gross Charge Type: Pharmacy | NDC EA = 15 APP "nystatin 100,000 units/mL Oral Susp [INYO]" 6227 CDM 66689-0008-02 NDC facility both 60 ML 72 72 Gross Charge Type: Pharmacy "nystatin 100,000 units/mL Oral Susp [INYO]" 6227 CDM 00121-0868-02 NDC facility both 60 ML 72 72 Gross Charge Type: Pharmacy "nystatin 100,000 units/mL Oral Susp [INYO]" 6227 CDM 60432-0537-60 NDC facility both 60 ML 84.7 84.7 Gross Charge Type: Pharmacy 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC TechFee 622701 CDM 450 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC TechFee 622701 CDM 450 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 62270 LUMBAR PUNCTURE CHARGE 622702 CDM 761 RC facility both 1511 1511 Gross Charge Type: NIHD_Hosp_Profee_Price 62270 LUMBAR PUNCTURE CHARGE 622702 CDM 761 RC facility both 1511 1511 Gross Charge Type: NIHD_Hosp_Profee_Price 62270 Lumbar Puncture (Spinal Tap) Charge 622703 CDM 761 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price 62270 Lumbar Puncture (Spinal Tap) Charge 622703 CDM 761 RC facility both 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price "62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC ProFee" 622704 CDM 982 RC 62270 HCPCS facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price "62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC ProFee" 622704 CDM 982 RC 62270 HCPCS facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price 62270 Diagnostic Spinal Tap 622705 CDM 963 RC 62270 HCPCS facility both 1194 1194 Gross Charge Type: NIHD_Hosp_Profee_Price 62270 Diagnostic Spinal Tap 622705 CDM 963 RC 62270 HCPCS facility both 1194 1194 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lumbar Puncture 622706 CDM 761 RC facility both TC 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lumbar Puncture 622706 CDM 761 RC facility both TC 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lumbar Puncture - Report 622707 CDM 972 RC 62270 HCPCS facility both 26 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lumbar Puncture - Report 622707 CDM 972 RC 62270 HCPCS facility both 26 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumbar Puncture 622708 CDM 761 RC facility both TC 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumbar Puncture 622708 CDM 761 RC facility both TC 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumbar Puncture - Report 622709 CDM 982 RC 62270 HCPCS facility both 26 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumbar Puncture - Report 622709 CDM 982 RC 62270 HCPCS facility both 26 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price "62272 SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHET ProFee" 62272 CDM 963 RC 62272 HCPCS facility both 1911 1911 Gross Charge Type: NIHD_Hosp_Profee_Price "62272 SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHET ProFee" 62272 CDM 963 RC 62272 HCPCS facility both 1911 1911 Gross Charge Type: NIHD_Hosp_Profee_Price "62273 INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH TechFee" 622731 CDM 450 RC facility both 1982 1982 Gross Charge Type: NIHD_Hosp_Profee_Price "62273 INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH TechFee" 622731 CDM 450 RC facility both 1982 1982 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Epidural Blood Patch 622733 CDM 761 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Epidural Blood Patch 622733 CDM 761 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Epidural Blood Patch - Report 622734 CDM 982 RC 62273 HCPCS facility both 26 409 409 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Epidural Blood Patch - Report 622734 CDM 982 RC 62273 HCPCS facility both 26 409 409 Gross Charge Type: NIHD_Hosp_Profee_Price "nystatin Top 100,000 units/g Oint [INYO]" 6228 CDM 00168-0007-15 NDC facility both 1 EA 84 84 Gross Charge Type: Pharmacy | NDC EA = 15 APP "62282 Injection/infusion of neurolytic substance; epidural, lumbar, sacral (caudal)" 62282 CDM 521 RC 62282 HCPCS facility both 493 493 Gross Charge Type: NIHD_RHC_Price "62282 Injection/infusion of neurolytic substance; epidural, lumbar, sacral (caudal)" 62282 CDM 521 RC 62282 HCPCS facility both 493 493 Gross Charge Type: NIHD_Clinic_Price XR Myelogram Injection 622842 CDM 761 RC facility both TC 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Injection 622842 CDM 761 RC facility both TC 1100 1100 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Injection - Report 622843 CDM 982 RC 62284 HCPCS facility both 26 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Injection - Report 622843 CDM 982 RC 62284 HCPCS facility both 26 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 62304 XR MYELOGRAM LUMBOSACRAL 62304 CDM 761 RC facility both TC 2671 2671 Gross Charge Type: NIHD_Hosp_Profee_Price 62304 XR MYELOGRAM LUMBOSACRAL 62304 CDM 761 RC facility both TC 2671 2671 Gross Charge Type: NIHD_Hosp_Profee_Price "62304 MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATIO ProFee" 623041 CDM 982 RC 62304 HCPCS facility both 26 177 177 Gross Charge Type: NIHD_Hosp_Profee_Price "62304 MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATIO ProFee" 623041 CDM 982 RC 62304 HCPCS facility both 26 177 177 Gross Charge Type: NIHD_Hosp_Profee_Price "62322 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC ProFee" 62322 CDM 963 RC 62322 HCPCS facility both 1278 1278 Gross Charge Type: NIHD_Hosp_Profee_Price "62322 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC ProFee" 62322 CDM 963 RC 62322 HCPCS facility both 1278 1278 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Lmbr/Scrl Epidural 623232 CDM 761 RC facility both TC 2640 2640 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Lmbr/Scrl Epidural 623232 CDM 761 RC facility both TC 2640 2640 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Lmbr/Scrl Epidural - Report 623233 CDM 982 RC 62323 HCPCS facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Lmbr/Scrl Epidural - Report 623233 CDM 982 RC 62323 HCPCS facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price primidone 250 mg Tab [INYO] 6238 CDM 00527-1231-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB naloxone 0.4 mg/mL Inj Sol [INYO] 6247 CDM J2310 HCPCS 00409-1215-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy naloxone 0.4 mg/mL Sol [INYO] 6247 CDM J2310 HCPCS 36000-0308-10 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy naloxone 0.4 mg/mL Inj Sol [INYO] 6247 CDM J2310 HCPCS 70069-0071-10 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy 90 x 20mm light cordless single use retractor 625 CDM 272 RC facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price 90 x 20mm light cordless single use retractor 625 CDM 272 RC facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price neomycin 500 mg Tab [INYO] 6276 CDM 00093-1177-01 NDC facility both 1 EA 8.92 8.92 Gross Charge Type: Pharmacy | NDC EA = 1 TAB neomycin 500 mg Tab [INYO] 6276 CDM 39822-0310-05 NDC facility both 1 EA 10.18 10.18 Gross Charge Type: Pharmacy | NDC EA = 1 TAB DRAIN LATEX MALECOT 4WING 18FR 6281880 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_RHC_Price DRAIN LATEX MALECOT 4WING 18FR 6281880 CDM 272 RC C1729 HCPCS facility both 31 31 Gross Charge Type: NIHD_Clinic_Price DRAIN LATEX MALECOT 4WING 18FR 6281880 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN LATEX MALECOT 4WING 18FR 6281880 CDM 272 RC facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price niacin 500 mg ER Tab [INYO] 6300 CDM 00074-3074-90 NDC facility both 1 EA 32.64 32.64 Gross Charge Type: Pharmacy | NDC EA = 1 TAB TUBING AQUILEX INFLOW (MYOSURE) 6335587 CDM 272 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price TUBING AQUILEX INFLOW (MYOSURE) 6335587 CDM 272 RC facility both 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price calcium carbonate 500 mg Chew Tab [INYO] 6336 CDM 57896-0763-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB calcium carbonate 500 mg Chew Tab [INYO] 6336 CDM 66553-0004-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB calcium carbonate 500 mg Chew Tab [INYO] 6336 CDM 50268-0149-13 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB calcium carbonate 500 mg Chew Tab [INYO] 6336 CDM 00536-1048-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB meperidine 25 mg/mL Inj Sol [INYO] 636 CDM J2175 HCPCS 00641-6052-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy APAP-oxyCODONE 325 mg-5 mg Tab [INYO] 6395 CDM 00406-0512-62 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB APAP-oxyCODONE 325 mg-5 mg Tab [INYO] 6395 CDM 00406-0512-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB promethazine 6.25 mg/5 mL Oral Syrup [INYO] 6414 CDM Q0169 HCPCS 57664-0146-31 NDC facility both 120 ML 44.1 44.1 Gross Charge Type: Pharmacy codeine-promethazine 10 mg-6.25 mg/5 mL Syr [INYO] 6415 CDM 27808-0065-02 NDC facility both 5 ML 35 35 Gross Charge Type: Pharmacy promethazine 25 mg/mL Inj Sol [INYO] 6422 CDM J2550 HCPCS 00641-0928-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy promethazine 25 mg/mL Inj Sol [INYO] 6422 CDM J2550 HCPCS 00641-6208-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy promethazine 25 mg/mL Inj Sol [INYO] 6422 CDM J2550 HCPCS 00641-6084-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy SIMPLEX CEMENT ONE UNIT 64345 CDM 278 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price SIMPLEX CEMENT ONE UNIT 64345 CDM 278 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price "64400 INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISION OR BRANCH ProFee" 64400 CDM 982 RC 64400 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "64400 INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISION OR BRANCH ProFee" 64400 CDM 982 RC 64400 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "64400 INJECTION, ANESTHETIC AGENT TechFee" 644001 CDM 450 RC facility both 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price "64400 INJECTION, ANESTHETIC AGENT TechFee" 644001 CDM 450 RC facility both 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV TechFee 64405 CDM 450 RC facility both 1102 1102 Gross Charge Type: NIHD_Hosp_Profee_Price 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV TechFee 64405 CDM 450 RC facility both 1102 1102 Gross Charge Type: NIHD_Hosp_Profee_Price "64405 INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE ProFee" 644051 CDM 982 RC 64405 HCPCS facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price "64405 INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE ProFee" 644051 CDM 982 RC 64405 HCPCS facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price 64415 Interscalene Block (Brachial Plexus Block) 64415 CDM 963 RC 64415 HCPCS facility both 1911 1911 Gross Charge Type: NIHD_Hosp_Profee_Price 64415 Interscalene Block (Brachial Plexus Block) 64415 CDM 963 RC 64415 HCPCS facility both 1911 1911 Gross Charge Type: NIHD_Hosp_Profee_Price "64416 INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (INCLUDI ProFee" 64416 CDM 963 RC 64416 HCPCS facility both 2045 2045 Gross Charge Type: NIHD_Hosp_Profee_Price "64416 INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (INCLUDI ProFee" 64416 CDM 963 RC 64416 HCPCS facility both 2045 2045 Gross Charge Type: NIHD_Hosp_Profee_Price "64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee" 64420 CDM 982 RC 64420 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price "64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE ProFee" 64420 CDM 982 RC 64420 HCPCS facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price "64425 Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal, iliohypogastric nerves" 644251 CDM 761 RC facility both 1520 1520 Gross Charge Type: NIHD_Hosp_Profee_Price "64425 Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal, iliohypogastric nerves" 644251 CDM 761 RC facility both 1520 1520 Gross Charge Type: NIHD_Hosp_Profee_Price "64425 INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES ProFee" 644252 CDM 982 RC 64425 HCPCS facility both 173 173 Gross Charge Type: NIHD_Hosp_Profee_Price "64425 INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES ProFee" 644252 CDM 982 RC 64425 HCPCS facility both 173 173 Gross Charge Type: NIHD_Hosp_Profee_Price "64425 Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves" 644253 CDM 521 RC 64425 HCPCS facility both 247 247 Gross Charge Type: NIHD_RHC_Price "64430 Injection, anesthetic agent; pudendal nerve" 64430 CDM 521 RC 64430 HCPCS facility both 162 162 Gross Charge Type: NIHD_RHC_Price "64430 Injection, anesthetic agent; pudendal nerve" 64430 CDM 521 RC 64430 HCPCS facility both 162 162 Gross Charge Type: NIHD_Clinic_Price "64435 Injection, anesthetic agent; paracervical (uterine) nerve" 64435 CDM 521 RC 64435 HCPCS facility both 462 462 Gross Charge Type: NIHD_RHC_Price "64445 Injection(s), anesthetic agent(s) and/or steroid; sciatic nerves" 64445 CDM 964 RC 64445 HCPCS facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price "64445 Injection(s), anesthetic agent(s) and/or steroid; sciatic nerves" 64445 CDM 964 RC 64445 HCPCS facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price 64447 Adductor Canal Block (Injection anesthetic agent: Femoral Nerve) 64447 CDM 963 RC 64447 HCPCS facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price 64447 Adductor Canal Block (Injection anesthetic agent: Femoral Nerve) 64447 CDM 963 RC 64447 HCPCS facility both 1672 1672 Gross Charge Type: NIHD_Hosp_Profee_Price 64450 PECS I Block (Injection anes agent: other peripheral nerve or branch) 64450 CDM 963 RC 64450 HCPCS facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price 64450 PECS I Block (Injection anes agent: other peripheral nerve or branch) 64450 CDM 963 RC 64450 HCPCS facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price "64450 Injection, anesthetic agent; other peripheral nerve or branch" 644501 CDM 521 RC 64450 HCPCS facility both 137 137 Gross Charge Type: NIHD_RHC_Price "64450 Injection, anesthetic agent; other peripheral nerve or branch" 644501 CDM 521 RC 64450 HCPCS facility both 137 137 Gross Charge Type: NIHD_Clinic_Price 64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH TechFee 644502 CDM 450 RC facility both 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price 64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH TechFee 644502 CDM 450 RC facility both 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price "64450 INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH ProFee" 644503 CDM 982 RC 64450 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "64450 INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH ProFee" 644503 CDM 982 RC 64450 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "64455 Injection,anesthetic agent and/or steroid, plantar common digital nerve(s)" 64455 CDM 521 RC 64455 HCPCS facility both 76 76 Gross Charge Type: NIHD_RHC_Price "64455 Injection,anesthetic agent and/or steroid, plantar common digital nerve(s)" 64455 CDM 521 RC 64455 HCPCS facility both 76 76 Gross Charge Type: NIHD_Clinic_Price "64461 PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION SITE (INCLUD ProFee" 64461 CDM 963 RC 64461 HCPCS facility both 1911 1911 Gross Charge Type: NIHD_Hosp_Profee_Price "64461 PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION SITE (INCLUD ProFee" 64461 CDM 963 RC 64461 HCPCS facility both 1911 1911 Gross Charge Type: NIHD_Hosp_Profee_Price XR Inj Lmbr/Scrl Foraminal Epidural 644831 CDM 320 RC facility both TC 1896 1896 Gross Charge Type: NIHD_Hosp_Profee_Price XR Inj Lmbr/Scrl Foraminal Epidural 644831 CDM 320 RC facility both TC 1896 1896 Gross Charge Type: NIHD_Hosp_Profee_Price XR Inj Lmbr/Scrl Foraminal Epidural - Report 644832 CDM 982 RC 64483 HCPCS facility both 26 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price XR Inj Lmbr/Scrl Foraminal Epidural - Report 644832 CDM 982 RC 64483 HCPCS facility both 26 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Lmbr/Scrl Foramina Epidural 644833 CDM 320 RC facility both TC 1896 1896 Gross Charge Type: NIHD_Hosp_Profee_Price XR Injection Lmbr/Scrl Foramina Epidural 644833 CDM 320 RC facility both TC 1896 1896 Gross Charge Type: NIHD_Hosp_Profee_Price "64483 Injection(s), anesthetic agent and/or steroid, w guidance; lumbar/sacral, each addl level" 644834 CDM 320 RC facility both TC 1896 1896 Gross Charge Type: NIHD_Hosp_Profee_Price "64483 Injection(s), anesthetic agent and/or steroid, w guidance; lumbar/sacral, each addl level" 644834 CDM 320 RC facility both TC 1896 1896 Gross Charge Type: NIHD_Hosp_Profee_Price 64483 Inj Foramen Epidural L/S 644835 CDM 982 RC 64483 HCPCS facility both 26 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 64483 Inj Foramen Epidural L/S 644835 CDM 982 RC 64483 HCPCS facility both 26 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR TRANSFORAMINAL LUMBAR EA ADDL 64484 CDM 320 RC facility both TC 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR TRANSFORAMINAL LUMBAR EA ADDL 64484 CDM 320 RC facility both TC 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price 64486 TAP Block Unilateral (Transversus Abdominis Plane) (Includes Imaging Guidance) 64486 CDM 963 RC 64486 HCPCS facility both 1194 1194 Gross Charge Type: NIHD_Hosp_Profee_Price 64486 TAP Block Unilateral (Transversus Abdominis Plane) (Includes Imaging Guidance) 64486 CDM 963 RC 64486 HCPCS facility both 1194 1194 Gross Charge Type: NIHD_Hosp_Profee_Price 64488 TAP Block Bilateral (Transversus Abdominis Plane) (Includes Imaging Guidance) 64488 CDM 963 RC 64488 HCPCS facility both 1194 1194 Gross Charge Type: NIHD_Hosp_Profee_Price 64488 TAP Block Bilateral (Transversus Abdominis Plane) (Includes Imaging Guidance) 64488 CDM 963 RC 64488 HCPCS facility both 1194 1194 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FACET INJ LUMB/SACR LV2 BILAT 644911 CDM 320 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FACET INJ LUMB/SACR LV2 BILAT 644911 CDM 320 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FACET INJ LUMB/SACR LV2 UNILAT 644912 CDM 320 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FACET INJ LUMB/SACR LV2 UNILAT 644912 CDM 320 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FLUORO GUIDANCE NEEDLE PLCMT 644931 CDM 320 RC facility both TC 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FLUORO GUIDANCE NEEDLE PLCMT 644931 CDM 320 RC facility both TC 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Right 6449310 CDM 320 RC facility both TCRT 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Right 6449310 CDM 320 RC facility both TCRT 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Right - Report 6449311 CDM 982 RC 64493 HCPCS facility both 26RT 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Right - Report 6449311 CDM 982 RC 64493 HCPCS facility both 26RT 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 64493 Facet Lumbar/Sacral 6449312 CDM 320 RC facility both TC 3640 3640 Gross Charge Type: NIHD_Hosp_Profee_Price 64493 Facet Lumbar/Sacral 6449312 CDM 320 RC facility both TC 3640 3640 Gross Charge Type: NIHD_Hosp_Profee_Price "64493 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOI ProFee" 6449313_1 CDM 982 RC 64493 HCPCS facility both 26 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "64493 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOI ProFee" 6449313_1 CDM 982 RC 64493 HCPCS facility both 26 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Bilat - Report 6449313_2 CDM 982 RC 64493 HCPCS facility both 2650 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Bilat - Report 6449313_2 CDM 982 RC 64493 HCPCS facility both 2650 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price CT Facet Injection Lumb/Sacr Lv1 644932 CDM 320 RC facility both TC 3640 3640 Gross Charge Type: NIHD_Hosp_Profee_Price CT Facet Injection Lumb/Sacr Lv1 644932 CDM 320 RC facility both TC 3640 3640 Gross Charge Type: NIHD_Hosp_Profee_Price CT Facet Injection Lumb/Sacr Lv1 - Report 644933 CDM 982 RC 64493 HCPCS facility both 26 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price CT Facet Injection Lumb/Sacr Lv1 - Report 644933 CDM 982 RC 64493 HCPCS facility both 26 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Left 644934 CDM 320 RC facility both TCLT 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Left 644934 CDM 320 RC facility both TCLT 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Left - Report 644935 CDM 975 RC 64493 HCPCS facility both 26LT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Left - Report 644935 CDM 975 RC 64493 HCPCS facility both 26LT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Right 644936 CDM 320 RC facility both TCRT 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Right 644936 CDM 320 RC facility both TCRT 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Right - Report 644937 CDM 975 RC 64493 HCPCS facility both 26RT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv1 Right - Report 644937 CDM 975 RC 64493 HCPCS facility both 26RT 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Left 644938 CDM 320 RC facility both TCLT 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Left 644938 CDM 320 RC facility both TCLT 1817 1817 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Left - Report 644939 CDM 982 RC 64493 HCPCS facility both 26LT 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Left - Report 644939 CDM 982 RC 64493 HCPCS facility both 26LT 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 64494 XR Facet Injection Lumb/Sacr Lv2 Bilat PROFEE 64494 CDM 975 RC 64494 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 64494 XR Facet Injection Lumb/Sacr Lv2 Bilat PROFEE 64494 CDM 975 RC 64494 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Bilat - Report 6449410 CDM 982 RC 64494 HCPCS facility both 2650 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Bilat - Report 6449410 CDM 982 RC 64494 HCPCS facility both 2650 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price 64494 XR Facet Injection Lumb/Sacr Lv2 Bilat 6449411 CDM 320 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 64494 XR Facet Injection Lumb/Sacr Lv2 Bilat 6449411 CDM 320 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FLUORO GUIDANCE 644943 CDM 320 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FLUORO GUIDANCE 644943 CDM 320 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Left 644945 CDM 320 RC facility both TCLT 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Left 644945 CDM 320 RC facility both TCLT 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Left - Report 644946 CDM 975 RC 64494 HCPCS facility both 26LT 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Left - Report 644946 CDM 975 RC 64494 HCPCS facility both 26LT 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Right 644947 CDM 320 RC facility both TCRT 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Right 644947 CDM 320 RC facility both TCRT 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Right - Report 644948 CDM 975 RC 64494 HCPCS facility both 26RT 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Right - Report 644948 CDM 975 RC 64494 HCPCS facility both 26RT 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Bilat 644949 CDM 320 RC facility both TC 1671 1671 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv2 Bilat 644949 CDM 320 RC facility both TC 1671 1671 Gross Charge Type: NIHD_Hosp_Profee_Price 64495 XR Facet Injection Lumb/Sacr Lv3+ Bilat PROFEE 644952 CDM 975 RC 64495 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 64495 XR Facet Injection Lumb/Sacr Lv3+ Bilat PROFEE 644952 CDM 975 RC 64495 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FACET INJ LUMB/SACR LV3+ BILAT 644955 CDM 320 RC facility both TC 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FACET INJ LUMB/SACR LV3+ BILAT 644955 CDM 320 RC facility both TC 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FACET INJ LUMB/SACR LV3+ UNILAT 644956 CDM 320 RC facility both TC 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FACET INJ LUMB/SACR LV3+ UNILAT 644956 CDM 320 RC facility both TC 807 807 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Bilat 644957 CDM 320 RC facility both TC 1613 1613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Bilat 644957 CDM 320 RC facility both TC 1613 1613 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Bilat - Report 644958 CDM 982 RC 64493 HCPCS facility both 2650 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facet Injection Lumb/Sacr Lv3+ Bilat - Report 644958 CDM 982 RC 64493 HCPCS facility both 2650 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price "64561 Percutaneous implantation of neuro electrode array;sacral nerve incl. image guidance,if needed" 64561 CDM 521 RC 64561 HCPCS facility both 50 1395 1395 Gross Charge Type: NIHD_RHC_Price "64561 Percutaneous implantation of neuro electrode array;sacral nerve incl. image guidance,if needed" 64561 CDM 521 RC 64561 HCPCS facility both 50 1395 1395 Gross Charge Type: NIHD_Clinic_Price 64561 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAM ProFee 645611 CDM 982 RC 64561 HCPCS facility both 907 907 Gross Charge Type: NIHD_Hosp_Profee_Price 64561 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAM ProFee 645611 CDM 982 RC 64561 HCPCS facility both 907 907 Gross Charge Type: NIHD_Hosp_Profee_Price 64561 Percutaneous implantation of neuro electrode array;sacral nerve incl 645612 CDM 761 RC facility both 7977 7977 Gross Charge Type: NIHD_Hosp_Profee_Price 64561 Percutaneous implantation of neuro electrode array;sacral nerve incl 645612 CDM 761 RC facility both 7977 7977 Gross Charge Type: NIHD_Hosp_Profee_Price 64585 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY ProFee 64585 CDM 982 RC 64585 HCPCS facility both 440 440 Gross Charge Type: NIHD_Hosp_Profee_Price 64585 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY ProFee 64585 CDM 982 RC 64585 HCPCS facility both 440 440 Gross Charge Type: NIHD_Hosp_Profee_Price 64590 INSERTION OR REPLACEMENT OF PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR R ProFee 64590 CDM 982 RC 64590 HCPCS facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price 64590 INSERTION OR REPLACEMENT OF PERIPHERAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR R ProFee 64590 CDM 982 RC 64590 HCPCS facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price 64590 Insertion or replacement of peripheral pulse generator/receiver (use with 4164561A) 645901 CDM 761 RC facility both 7280 7280 Gross Charge Type: NIHD_Hosp_Profee_Price 64590 Insertion or replacement of peripheral pulse generator/receiver (use with 4164561A) 645901 CDM 761 RC facility both 7280 7280 Gross Charge Type: NIHD_Hosp_Profee_Price bacitracin-polymyxin B Ophth Oint [INYO] 6460 CDM 24208-0555-55 NDC facility both 1 EA 143.25 143.25 Gross Charge Type: Pharmacy | NDC EA = 3.5 APP "64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral" 64612 CDM 521 RC 64612 HCPCS facility both 208 208 Gross Charge Type: NIHD_RHC_Price "64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral" 64612 CDM 521 RC 64612 HCPCS facility both 208 208 Gross Charge Type: NIHD_Clinic_Price 64615 botox/migraine 646158 CDM 521 RC 64615 HCPCS facility both 264 264 Gross Charge Type: NIHD_RHC_Price 64615 botox/migraine 646158 CDM 521 RC 64615 HCPCS facility both 264 264 Gross Charge Type: NIHD_Clinic_Price zzNIHD XR VCUG CONTRAST INJECTION 64634 CDM 361 RC facility both TC 608 608 Gross Charge Type: NIHD_Hosp_Profee_Price zzNIHD XR VCUG CONTRAST INJECTION 64634 CDM 361 RC facility both TC 608 608 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumb/Sacr Nerve Ablation Left 646351 CDM 361 RC facility both TCLT 2645 2645 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumb/Sacr Nerve Ablation Left 646351 CDM 361 RC facility both TCLT 2645 2645 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumb/Sacr Nerve Ablation Left - Report 646352 CDM 960 RC 64635 HCPCS facility both 26LT 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumb/Sacr Nerve Ablation Left - Report 646352 CDM 960 RC 64635 HCPCS facility both 26LT 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumb/Sacr Nerve Ablation Right 646353 CDM 361 RC facility both TCRT 2645 2645 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumb/Sacr Nerve Ablation Right 646353 CDM 361 RC facility both TCRT 2645 2645 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumb/Sacr Nerve Ablation Right - Report 646354 CDM 960 RC 64635 HCPCS facility both 26RT 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lumb/Sacr Nerve Ablation Right - Report 646354 CDM 960 RC 64635 HCPCS facility both 26RT 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price potassium chloride 40 mEq/20 mL IV Sol [INYO] 6468 CDM J3480 HCPCS 63323-0965-20 NDC facility both 20 ML 330 330 Gross Charge Type: Pharmacy potassium chloride 40 mEq/20 mL IV Sol [INYO] 6468 CDM J3480 HCPCS 00409-6653-05 NDC facility both 20 ML 330 330 Gross Charge Type: Pharmacy potassium chloride 20 mEq/15 mL Oral Liq [INYO] 6469 CDM 00904-7061-87 NDC facility both 15 ML 58 58 Gross Charge Type: Pharmacy potassium chloride 20 mEq/15 mL Oral Liq [INYO] 6469 CDM 81033-0220-52 NDC facility both 15 ML 25.2 25.2 Gross Charge Type: Pharmacy potassium chloride 20 mEq/15 mL Oral Liq [INYO] 6469 CDM 00121-1465-15 NDC facility both 15 ML 32.51 32.51 Gross Charge Type: Pharmacy 64704 NEUROPLASTY; NERVE OF HAND OR FOOT ProFee 64704 CDM 982 RC 64704 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 64704 NEUROPLASTY; NERVE OF HAND OR FOOT ProFee 64704 CDM 982 RC 64704 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price "64708 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED ProFee" 64708 CDM 982 RC 64708 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price "64708 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED ProFee" 64708 CDM 982 RC 64708 HCPCS facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price 64718 NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW ProFee 64718 CDM 982 RC 64718 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 64718 NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW ProFee 64718 CDM 982 RC 64718 HCPCS facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL ProFee 64721 CDM 982 RC 64721 HCPCS facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL ProFee 64721 CDM 982 RC 64721 HCPCS facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price prednisoLONE Ophth acetate 1% Susp [INYO] 6480 CDM 61314-0637-05 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS conjugated estrogens 25 mg IV Inj [INYO] 6485 CDM J1410 HCPCS 00046-0749-05 NDC facility both 1 EA 1121.91 1121.91 Gross Charge Type: Pharmacy conjugated estrogens 0.625 mg/g Vag Crm w/Appl [INYO] 6491 CDM 00046-0872-21 NDC facility both 1 EA 1882.76 1882.76 Gross Charge Type: Pharmacy | NDC EA = 30 APP Prenatal Multivitamins with Folic Acid 0.8 mg Tab [INYO] 6492 CDM 77333-0715-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Prenatal Multivitamins with Folic Acid 0.8 mg Tab [INYO] 6492 CDM 00536-4085-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "64999 UNLISTED PROCEDURE, NERVOUS SYSTEM ProFee" 64999 CDM 963 RC 64999 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price "64999 UNLISTED PROCEDURE, NERVOUS SYSTEM ProFee" 64999 CDM 963 RC 64999 HCPCS facility both 649 649 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 3-0 CV-23 6 IN 90 ABSORBABLE 6500859 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 3-0 CV-23 6 IN 90 ABSORBABLE 6500859 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 3-0 CV-23 9 IN 90 ABSORBABLE 6500861 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 3-0 CV-23 9 IN 90 ABSORBABLE 6500861 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING HEEL ALLEVYN LIFE 25CM X 25CM 6501304 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING HEEL ALLEVYN LIFE 25CM X 25CM 6501304 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL LOCK 2.3X18MM ACUMED 6504007 CDM 278 RC facility both 499 499 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL LOCK 2.3X18MM ACUMED 6504007 CDM 278 RC facility both 499 499 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL ACUMED 2.3X18MM 6504010 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL ACUMED 2.3X18MM 6504010 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL ACUMED 2.3X16MM 6504012 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL ACUMED 2.3X16MM 6504012 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE ACUMED 0.045X6 6504015 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE ACUMED 0.045X6 6504015 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price BRONCHO CATHETER 37 6504048 CDM 278 RC facility both 206 206 Gross Charge Type: NIHD_Hosp_Profee_Price BRONCHO CATHETER 37 6504048 CDM 278 RC facility both 206 206 Gross Charge Type: NIHD_Hosp_Profee_Price BRONCHO CATHETER 39 6504049 CDM 278 RC facility both 206 206 Gross Charge Type: NIHD_Hosp_Profee_Price BRONCHO CATHETER 39 6504049 CDM 278 RC facility both 206 206 Gross Charge Type: NIHD_Hosp_Profee_Price BRONCHO CATHETER 41 6504050 CDM 278 RC facility both 206 206 Gross Charge Type: NIHD_Hosp_Profee_Price BRONCHO CATHETER 41 6504050 CDM 278 RC facility both 206 206 Gross Charge Type: NIHD_Hosp_Profee_Price BRONCHO CATHETER 35 6504058 CDM 278 RC facility both 206 206 Gross Charge Type: NIHD_Hosp_Profee_Price BRONCHO CATHETER 35 6504058 CDM 278 RC facility both 206 206 Gross Charge Type: NIHD_Hosp_Profee_Price CRICOTHYROTOMY AIRWAY C-T-CCS-400 6504060 CDM 272 RC facility both 482 482 Gross Charge Type: NIHD_Hosp_Profee_Price CRICOTHYROTOMY AIRWAY C-T-CCS-400 6504060 CDM 272 RC facility both 482 482 Gross Charge Type: NIHD_Hosp_Profee_Price AIRWAY CATH 8.0 6504128 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price AIRWAY CATH 8.0 6504128 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price AIRWAY CATH 11.0 6504129 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price AIRWAY CATH 11.0 6504129 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price AIRWAY CATH 14.0 6504130 CDM 272 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price AIRWAY CATH 14.0 6504130 CDM 272 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price AIRWAY CATH 19.0 6504131 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price AIRWAY CATH 19.0 6504131 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SPINAL WHITACRE 22GX3.5 6504157 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLE SPINAL WHITACRE 22GX3.5 6504157 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR 4.0 DISSECTOR CURVED AR-8400CDS 6505221 CDM 272 RC facility both 198 198 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR 4.0 DISSECTOR CURVED AR-8400CDS 6505221 CDM 272 RC facility both 198 198 Gross Charge Type: NIHD_Hosp_Profee_Price STEM FLUTED 14MMX100MM 65061015 CDM 278 RC facility both 6127 6127 Gross Charge Type: NIHD_Hosp_Profee_Price STEM FLUTED 14MMX100MM 65061015 CDM 278 RC facility both 6127 6127 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL HEAD 28.0MM LEFT 6508000 CDM 278 RC facility both 10258 10258 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL HEAD 28.0MM LEFT 6508000 CDM 278 RC facility both 10258 10258 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 11 FMMC STANDAR 65080001 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 11 FMMC STANDAR 65080001 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR FLEX E- LEFT 65080002 CDM 278 RC facility both 22139 22139 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR FLEX E- LEFT 65080002 CDM 278 RC facility both 22139 22139 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW MICRO ACUTRAK 2 14.0MM 65080003 CDM facility both 1344 1344 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW MICRO ACUTRAK 2 14.0MM 65080003 CDM facility both 1344 1344 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW MICRO ACUTRAK 2 16.0MM 65080004 CDM facility both 2159 2159 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW MICRO ACUTRAK 2 16.0MM 65080004 CDM facility both 2159 2159 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF F- LEFT 65080007 CDM 278 RC facility both 23747 23747 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF F- LEFT 65080007 CDM 278 RC facility both 23747 23747 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW MINI ACUTRAK 2 18.0MM 65080008 CDM facility both 1732 1732 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW MINI ACUTRAK 2 18.0MM 65080008 CDM facility both 1732 1732 Gross Charge Type: NIHD_Hosp_Profee_Price AUGMENT BLOCK 5MM SIZE 6 TIBIAL 65080059 CDM facility both 8816 8816 Gross Charge Type: NIHD_Hosp_Profee_Price AUGMENT BLOCK 5MM SIZE 6 TIBIAL 65080059 CDM facility both 8816 8816 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC SHORT RT 65080060 CDM 278 RC facility both 4168 4168 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC SHORT RT 65080060 CDM 278 RC facility both 4168 4168 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TENODENSIS 8X12 MM 65080065 CDM 278 RC facility both 1036 1036 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TENODENSIS 8X12 MM 65080065 CDM 278 RC facility both 1036 1036 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW INTERFERENCE 7X23 MM 65080066 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW INTERFERENCE 7X23 MM 65080066 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW INTERFERENCE 7X28 MM 65080067 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW INTERFERENCE 7X28 MM 65080067 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 9X23 MM 65080069 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 9X23 MM 65080069 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 8X28 MM 65080070 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 8X28 MM 65080070 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 9X28 MM 65080071 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 9X28 MM 65080071 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW INTERFERENCE 11X28 MM 65080073 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW INTERFERENCE 11X28 MM 65080073 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 12X28 MM 65080074 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 12X28 MM 65080074 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW INTERFERENCE 8X20MM 65080077 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW INTERFERENCE 8X20MM 65080077 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X360MMX130 RT 65080097 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X360MMX130 RT 65080097 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 9X35MM 65080102 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 9X35MM 65080102 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 10X35MM 65080103 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIOCOMPOSITE INTERFERENCE 10X35MM 65080103 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREWS BIOCOMPOSITE INTERFERENCE 11X35MM 65080104 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREWS BIOCOMPOSITE INTERFERENCE 11X35MM 65080104 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREWS BIOCOMPOSITE INTERFERENCE 12X35MM 65080105 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREWS BIOCOMPOSITE INTERFERENCE 12X35MM 65080105 CDM 278 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 2.0 WITH #1 FIBERWIRE 65080106 CDM 278 RC facility both 916 916 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 2.0 WITH #1 FIBERWIRE 65080106 CDM 278 RC facility both 916 916 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 2.0 DISPOSABLES KIT 65080107 CDM 278 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE TAK 2.0 DISPOSABLES KIT 65080107 CDM 278 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price PUSHLOCK 2.9 AR-1923BC 65080108 CDM 278 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price PUSHLOCK 2.9 AR-1923BC 65080108 CDM 278 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price PUSHLOCK DISPOSABLE KIT 2.9 65080109 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price PUSHLOCK DISPOSABLE KIT 2.9 65080109 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X380MMX125 LT 65080120 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 11X380MMX125 LT 65080120 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 14 EXT NECK 65080163 CDM 278 RC facility both 24376 24376 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 14 EXT NECK 65080163 CDM 278 RC facility both 24376 24376 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP NECK +3.5MM 65080164 CDM 278 RC facility both 4348 4348 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP NECK +3.5MM 65080164 CDM 278 RC facility both 4348 4348 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE NN VIVACIT-E 65080165 CDM 278 RC facility both 8246 8246 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE NN VIVACIT-E 65080165 CDM 278 RC facility both 8246 8246 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 14 FMMC STD/STD 65080172 CDM 278 RC facility both 21797 21797 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 14 FMMC STD/STD 65080172 CDM 278 RC facility both 21797 21797 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 GUIDE PIN 4X400MM 65080174 CDM 272 RC facility both 519 519 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 GUIDE PIN 4X400MM 65080174 CDM 272 RC facility both 519 519 Gross Charge Type: NIHD_Hosp_Profee_Price FAST FIX 360 STRIAGHT NDL DELIVERY SYSTE 65080176 CDM 278 RC facility both 1674 1674 Gross Charge Type: NIHD_Hosp_Profee_Price FAST FIX 360 STRIAGHT NDL DELIVERY SYSTE 65080176 CDM 278 RC facility both 1674 1674 Gross Charge Type: NIHD_Hosp_Profee_Price FAST FIX 360 CURVED DELIVERY SYSTEM 65080177 CDM 278 RC facility both 1725 1725 Gross Charge Type: NIHD_Hosp_Profee_Price FAST FIX 360 CURVED DELIVERY SYSTEM 65080177 CDM 278 RC facility both 1725 1725 Gross Charge Type: NIHD_Hosp_Profee_Price FAST-FIX 360 REVERSE CURVE NDL 72202469 65080178 CDM 278 RC facility both 1725 1725 Gross Charge Type: NIHD_Hosp_Profee_Price FAST-FIX 360 REVERSE CURVE NDL 72202469 65080178 CDM 278 RC facility both 1725 1725 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ4 OMNIFIT EON CEMENT 65080181 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ4 OMNIFIT EON CEMENT 65080181 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ5 OMNIFIT EON CEMENT 65080182 CDM 278 RC facility both 15040 15040 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ5 OMNIFIT EON CEMENT 65080182 CDM 278 RC facility both 15040 15040 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ6 OMNIFIT EON CEMENT 65080183 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ6 OMNIFIT EON CEMENT 65080183 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ7 OMNIFIT EON CEMENT 65080184 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ7 OMNIFIT EON CEMENT 65080184 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ8 OMNIFIT EON CEMENT 65080185 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ8 OMNIFIT EON CEMENT 65080185 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ9 OMNIFIT EON CEMENT 65080186 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ9 OMNIFIT EON CEMENT 65080186 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ10 OMNIFIT EON CEMENT 65080187 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ10 OMNIFIT EON CEMENT 65080187 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ11 OMNIFIT EON CEMENT 65080188 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ11 OMNIFIT EON CEMENT 65080188 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ4 OMNIFIT EON P CEMENT 65080189 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ4 OMNIFIT EON P CEMENT 65080189 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ5 OMNIFIT EON P CEMENT 65080190 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ5 OMNIFIT EON P CEMENT 65080190 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ6 OMNIFIT EON P CEMENT 65080191 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ6 OMNIFIT EON P CEMENT 65080191 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ7 OMNIFIT EON P CEMENT 65080192 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ7 OMNIFIT EON P CEMENT 65080192 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ8 OMNIFIT EON P CEMENT 65080193 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ8 OMNIFIT EON P CEMENT 65080193 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ9 OMNIFIT EON P CEMENT 65080194 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ9 OMNIFIT EON P CEMENT 65080194 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ10 OMNIFIT EON P CEMEN 65080195 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ10 OMNIFIT EON P CEMEN 65080195 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ11 OMNIFIT EON P CEMEN 65080196 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 127DEG SZ11 OMNIFIT EON P CEMEN 65080196 CDM 278 RC facility both 15489 15489 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST C-TPR -3MM 65080197 CDM 278 RC facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST C-TPR -3MM 65080197 CDM 278 RC facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST C-TPR +0MM 65080198 CDM 278 RC facility both 850 850 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST C-TPR +0MM 65080198 CDM 278 RC facility both 850 850 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST C-TPR +5MM 65080199 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST C-TPR +5MM 65080199 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST C-TPR +10MM 65080200 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST C-TPR +10MM 65080200 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST V40 +12MM 65080201 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST V40 +12MM 65080201 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST V40 -4MM 65080202 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST V40 -4MM 65080202 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST V40 STDMM 65080203 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST V40 STDMM 65080203 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST V40 +4MM 65080204 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price SLEEVE NECK ADJUST V40 +4MM 65080204 CDM 278 RC facility both 888 888 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR LFIT 28MM -3 OFFSET 65080206 CDM 278 RC facility both 3640 3640 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR LFIT 28MM -3 OFFSET 65080206 CDM 278 RC facility both 3640 3640 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR LFIT 28MM +0 OFFSET 65080207 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR LFIT 28MM +0 OFFSET 65080207 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR LFIT 28MM +5 OFFSET 65080208 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR LFIT 28MM +5 OFFSET 65080208 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR 28MM +2.5 OFFSET 65080209 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR 28MM +2.5 OFFSET 65080209 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR 28MM +7.5 OFFSET 65080210 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR 28MM +7.5 OFFSET 65080210 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR LFIT 28MM +10 OFFSET 65080211 CDM 278 RC facility both 3640 3640 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD C-TPR LFIT 28MM +10 OFFSET 65080211 CDM 278 RC facility both 3640 3640 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 8MM 65080212 CDM 278 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 8MM 65080212 CDM 278 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 9MM 65080213 CDM 278 RC facility both 636 636 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 9MM 65080213 CDM 278 RC facility both 636 636 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 10MM 65080214 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 10MM 65080214 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 11MM 65080215 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 11MM 65080215 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 12MM 65080216 CDM 278 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 12MM 65080216 CDM 278 RC facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 13MM 65080217 CDM 278 RC facility both 636 636 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 13MM 65080217 CDM 278 RC facility both 636 636 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 14MM 65080218 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 14MM 65080218 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 15MM 65080219 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 15MM 65080219 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 16MM 65080220 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 16MM 65080220 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 17MM 65080221 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 17MM 65080221 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 18MM 65080222 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT SPACER OMNIFIT 18MM 65080222 CDM 278 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 38MM 65080223 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 38MM 65080223 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 40MM 65080224 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 40MM 65080224 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 41MM 65080225 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 41MM 65080225 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 42MM 65080226 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 42MM 65080226 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 43MM 65080227 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 43MM 65080227 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 44MM 65080228 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 44MM 65080228 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 45MM 65080229 CDM 278 RC facility both 3926 3926 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 45MM 65080229 CDM 278 RC facility both 3926 3926 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 46MM 65080230 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 46MM 65080230 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 47MM 65080231 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 47MM 65080231 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 48MM 65080232 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 48MM 65080232 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 49MM 65080233 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 49MM 65080233 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 50MM 65080234 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 50MM 65080234 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 51MM 65080235 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 51MM 65080235 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 52MM 65080236 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 52MM 65080236 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 53MM 65080237 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 53MM 65080237 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 54MM 65080238 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 54MM 65080238 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 55MM 65080239 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 55MM 65080239 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 56MM 65080240 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 56MM 65080240 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 58MM 65080241 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 58MM 65080241 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 61MM 65080242 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD UNITRAX ENDO 61MM 65080242 CDM 278 RC facility both 4042 4042 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 11 STD NECK 65080245 CDM 278 RC facility both 24866 24866 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 11 STD NECK 65080245 CDM 278 RC facility both 24866 24866 Gross Charge Type: NIHD_Hosp_Profee_Price BONE VOID FILLER STIMULAN 10CC 65080248 CDM 278 RC facility both 5383 5383 Gross Charge Type: NIHD_Hosp_Profee_Price BONE VOID FILLER STIMULAN 10CC 65080248 CDM 278 RC facility both 5383 5383 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X300MMX125 LT 65080256 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X300MMX125 LT 65080256 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X320MMX125 LT 65080257 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X320MMX125 LT 65080257 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X340MMX125 LT 65080258 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X340MMX125 LT 65080258 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X360MMX125 LT 65080259 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X360MMX125 LT 65080259 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X380MMX125 LT 65080260 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X380MMX125 LT 65080260 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X400MMX125 LT 65080261 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X400MMX125 LT 65080261 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X420MMX125 LT 65080262 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X420MMX125 LT 65080262 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X440MMX125 LT 65080263 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X440MMX125 LT 65080263 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X300MMX125 RT 65080264 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X300MMX125 RT 65080264 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X320MMX125 RT 65080265 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X320MMX125 RT 65080265 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X340MMX125 RT 65080266 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X340MMX125 RT 65080266 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X360MMX125 RT 65080267 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X360MMX125 RT 65080267 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X380MMX125 RT 65080268 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X380MMX125 RT 65080268 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X400MMX125 RT 65080269 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X400MMX125 RT 65080269 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X420MMX125 RT 65080270 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X420MMX125 RT 65080270 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X440MMX125 RT 65080271 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price GAMMA3 NAIL 13X440MMX125 RT 65080271 CDM 278 RC facility both 9243 9243 Gross Charge Type: NIHD_Hosp_Profee_Price CENTRALIZER DISTAL VERSYS 12MM 6508048 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price CENTRALIZER DISTAL VERSYS 12MM 6508048 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X30MM 6508049C CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X30MM 6508049C CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price CENTRALIZER DISTAL VERSYS 13MM 6508053 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price CENTRALIZER DISTAL VERSYS 13MM 6508053 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 5HL STAND BARREL 6508055 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 5HL STAND BARREL 6508055 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE PROXIMAL LATERAL HUMERUS 5 HOLE 65080800 CDM 278 RC facility both 5333 5333 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE PROXIMAL LATERAL HUMERUS 5 HOLE 65080800 CDM 278 RC facility both 5333 5333 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT CALIB 2.5X230MM AO 65080807 CDM 272 RC facility both 768 768 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT CALIB 2.5X230MM AO 65080807 CDM 272 RC facility both 768 768 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SZ JJ 65080810 CDM 278 RC facility both 9592 9592 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SZ JJ 65080810 CDM 278 RC facility both 9592 9592 Gross Charge Type: NIHD_Hosp_Profee_Price PUSH LOCK 3.5 X 19.5MM 65080824 CDM 278 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price PUSH LOCK 3.5 X 19.5MM 65080824 CDM 278 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price PUSH LOCK KIT FOR 3.5 X 19.5MM 65080825 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price PUSH LOCK KIT FOR 3.5 X 19.5MM 65080825 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price PUSH LOCK 2.9 X 12.5MM 65080826 CDM 278 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price PUSH LOCK 2.9 X 12.5MM 65080826 CDM 278 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price LABRAL TAPE 65080827 CDM 272 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price LABRAL TAPE 65080827 CDM 272 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHT ROPE KNOTLESS SYNDESMOSIS REPAIR 65080829 CDM 278 RC facility both 3524 3524 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHT ROPE KNOTLESS SYNDESMOSIS REPAIR 65080829 CDM 278 RC facility both 3524 3524 Gross Charge Type: NIHD_Hosp_Profee_Price BIOTENDONESIS KIT AR-1676DS 65080831 CDM 278 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price BIOTENDONESIS KIT AR-1676DS 65080831 CDM 278 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRI-LOCK 12/14 - SIZE 5 STD 65080832 CDM 278 RC facility both 28165 28165 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRI-LOCK 12/14 - SIZE 5 STD 65080832 CDM 278 RC facility both 28165 28165 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 54MM - DEPUY 65080834 CDM 278 RC facility both 14308 14308 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 54MM - DEPUY 65080834 CDM 278 RC facility both 14308 14308 Gross Charge Type: NIHD_Hosp_Profee_Price ACET LINER NEUTRAL 36MM ID 54MM OD 65080835 CDM 278 RC facility both 9131 9131 Gross Charge Type: NIHD_Hosp_Profee_Price ACET LINER NEUTRAL 36MM ID 54MM OD 65080835 CDM 278 RC facility both 9131 9131 Gross Charge Type: NIHD_Hosp_Profee_Price HOLE ELIMINATOR - DEPUY 65080836 CDM 278 RC facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price HOLE ELIMINATOR - DEPUY 65080836 CDM 278 RC facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X35MM - DEPUY 65080837 CDM 278 RC facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X35MM - DEPUY 65080837 CDM 278 RC facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X20MM- DEPUY 65080838 CDM 278 RC facility both 850 850 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X20MM- DEPUY 65080838 CDM 278 RC facility both 850 850 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X25MM- DEPUY 65080841 CDM 278 RC facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X25MM- DEPUY 65080841 CDM 278 RC facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price ACET LINER NEUTRAL 36MM ID 52MM OD 65080842 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price ACET LINER NEUTRAL 36MM ID 52MM OD 65080842 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM +1.5 12/14 TAPER DEPUY 1365-51-000 65080843 CDM 278 RC facility both 5503 5503 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM +1.5 12/14 TAPER DEPUY 1365-51-000 65080843 CDM 278 RC facility both 5503 5503 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 52MM - DEPUY 65080844 CDM 278 RC facility both 14096 14096 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 52MM - DEPUY 65080844 CDM 278 RC facility both 14096 14096 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X30MM - DEPUY 65080845 CDM 278 RC facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X30MM - DEPUY 65080845 CDM 278 RC facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X15MM - DEPUY 65080846 CDM 278 RC facility both 850 850 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X15MM - DEPUY 65080846 CDM 278 RC facility both 850 850 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CANCELLOUS CHIPS 4-10MM 15CC FD 65080850 CDM 278 RC facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CANCELLOUS CHIPS 4-10MM 15CC FD 65080850 CDM 278 RC facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CANCELLOUS CHIPS 4-10MM 30CC FD 65080851 CDM 278 RC facility both 1458 1458 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CANCELLOUS CHIPS 4-10MM 30CC FD 65080851 CDM 278 RC facility both 1458 1458 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 6 HOLE 4.0 COMPRESSION STYKER 65080857 CDM facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 6 HOLE 4.0 COMPRESSION STYKER 65080857 CDM facility both 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price CLIPS LIGATION X--LG (AESCULAP-PL475SU) 65080862 CDM 278 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price CLIPS LIGATION X--LG (AESCULAP-PL475SU) 65080862 CDM 278 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL BICEP REPAIR KIT ARTHREX AR-2260 65080863 CDM 278 RC facility both 2549 2549 Gross Charge Type: NIHD_Hosp_Profee_Price DISTAL BICEP REPAIR KIT ARTHREX AR-2260 65080863 CDM 278 RC facility both 2549 2549 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 2 LEFT 65080906 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 2 LEFT 65080906 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASE PLATE UNIVERSAL SZ 2 65080907 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASE PLATE UNIVERSAL SZ 2 65080907 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price SYMMETRIC PATELLA SZ S27MMX8MM 65080908 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price SYMMETRIC PATELLA SZ S27MMX8MM 65080908 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2X11MM 65080909 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2X11MM 65080909 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM +8.5 12/14 TAPER DEPUY 65080917 CDM 278 RC facility both 5841 5841 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM +8.5 12/14 TAPER DEPUY 65080917 CDM 278 RC facility both 5841 5841 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF E LEFT 65080918 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF E LEFT 65080918 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF E RIGHT 65080919 CDM 278 RC facility both 22139 22139 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF E RIGHT 65080919 CDM 278 RC facility both 22139 22139 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR 6.5 METAL CORKSCREW 65080920 CDM 272 RC facility both 735 735 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR 6.5 METAL CORKSCREW 65080920 CDM 272 RC facility both 735 735 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMANN PIN 3.2MM 9 INCH BIOMET 65080923 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMANN PIN 3.2MM 9 INCH BIOMET 65080923 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMANN PIN 1/8X2.5 BIOMET 65080924 CDM 278 RC facility both 1170 1170 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMANN PIN 1/8X2.5 BIOMET 65080924 CDM 278 RC facility both 1170 1170 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM SMALL HYBRID GLENOID BASE PT-113950 65080925 CDM 278 RC facility both 7976 7976 Gross Charge Type: NIHD_Hosp_Profee_Price 4MM SMALL HYBRID GLENOID BASE PT-113950 65080925 CDM 278 RC facility both 7976 7976 Gross Charge Type: NIHD_Hosp_Profee_Price HYBRID GLENOID POST REGENEREX 65080926 CDM 278 RC facility both 2369 2369 Gross Charge Type: NIHD_Hosp_Profee_Price HYBRID GLENOID POST REGENEREX 65080926 CDM 278 RC facility both 2369 2369 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 15X83 MM LONG 65080927 CDM 278 RC facility both 19411 19411 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 15X83 MM LONG 65080927 CDM 278 RC facility both 19411 19411 Gross Charge Type: NIHD_Hosp_Profee_Price VERSA -DIAL STANDARD ADAPTOR TOT SHOULDE 65080928 CDM 278 RC facility both 990 990 Gross Charge Type: NIHD_Hosp_Profee_Price VERSA -DIAL STANDARD ADAPTOR TOT SHOULDE 65080928 CDM 278 RC facility both 990 990 Gross Charge Type: NIHD_Hosp_Profee_Price MODULAR HEAD 50MM X 24MM X52MM 65080929 CDM 278 RC facility both 8144 8144 Gross Charge Type: NIHD_Hosp_Profee_Price MODULAR HEAD 50MM X 24MM X52MM 65080929 CDM 278 RC facility both 8144 8144 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE 2.3X22MM TORX 65080941 CDM 278 RC facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE 2.3X22MM TORX 65080941 CDM 278 RC facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 10 X83 LONG 65080944 CDM 278 RC facility both 19411 19411 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 10 X83 LONG 65080944 CDM 278 RC facility both 19411 19411 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 11X83MM LONG 65080945 CDM 278 RC facility both 20587 20587 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 11X83MM LONG 65080945 CDM 278 RC facility both 20587 20587 Gross Charge Type: NIHD_Hosp_Profee_Price MODULAR HEAD 46 MM X 18 MM X 53 MM 65080946 CDM 278 RC facility both 9115 9115 Gross Charge Type: NIHD_Hosp_Profee_Price MODULAR HEAD 46 MM X 18 MM X 53 MM 65080946 CDM 278 RC facility both 9115 9115 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMANN PIN THREADED REVERSE - BIOMET 65080962 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMANN PIN THREADED REVERSE - BIOMET 65080962 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.7MM - PERIPHERAL SCREW 65080963 CDM 272 RC facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.7MM - PERIPHERAL SCREW 65080963 CDM 272 RC facility both 870 870 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2MM - CENTRAL SCREW 65080964 CDM 272 RC facility both 579 579 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2MM - CENTRAL SCREW 65080964 CDM 272 RC facility both 579 579 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE BASE PLATE - GLENOSPHERE HA 65080965 CDM 278 RC facility both 8125 8125 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE BASE PLATE - GLENOSPHERE HA 65080965 CDM 278 RC facility both 8125 8125 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5MMX35MM CENTRAL 65080966 CDM 278 RC facility both 711 711 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5MMX35MM CENTRAL 65080966 CDM 278 RC facility both 711 711 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5MM HEX 4.75X35MM 65080967 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5MM HEX 4.75X35MM 65080967 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE GLENOSPHERE 36MM OF CURVED/STAND 65080968 CDM 278 RC facility both 6836 6836 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE GLENOSPHERE 36MM OF CURVED/STAND 65080968 CDM 278 RC facility both 6836 6836 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 10 X122MM 65080969 CDM facility both 17034 17034 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 10 X122MM 65080969 CDM facility both 17034 17034 Gross Charge Type: NIHD_Hosp_Profee_Price REV HUMERAL TRAY 44MM W LOCKING RING 65080970 CDM 278 RC facility both 7901 7901 Gross Charge Type: NIHD_Hosp_Profee_Price REV HUMERAL TRAY 44MM W LOCKING RING 65080970 CDM 278 RC facility both 7901 7901 Gross Charge Type: NIHD_Hosp_Profee_Price REV HUMERAL BEARING +3X44X36MM CURVED 65080971 CDM 278 RC facility both 4648 4648 Gross Charge Type: NIHD_Hosp_Profee_Price REV HUMERAL BEARING +3X44X36MM CURVED 65080971 CDM 278 RC facility both 4648 4648 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 8 NEXGEN 65080999 CDM 278 RC facility both 10824 10824 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 8 NEXGEN 65080999 CDM 278 RC facility both 10824 10824 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE CERCLAGE 1.25MM 18 GAUGE UNSTERILE 6508100 CDM 278 RC facility both 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE CERCLAGE 1.25MM 18 GAUGE UNSTERILE 6508100 CDM 278 RC facility both 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0X58MM 65081015 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0X58MM 65081015 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0X64MM 65081018 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0X64MM 65081018 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0X68MM 65081020 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0X68MM 65081020 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0 X 72 MM 65081022 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0 X 72 MM 65081022 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0 X 76 MM 65081024 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0 X 76 MM 65081024 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0 X 80 MM 65081026 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TIT W T25 STARDR 5.0 X 80 MM 65081026 CDM 278 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 5HL STAND BARREL 6508108 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 5HL STAND BARREL 6508108 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 6 LEFT 65081094 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 6 LEFT 65081094 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 6 X11MM 65081095 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 6 X11MM 65081095 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA SYMMETRIC SZ S36MM X 10MM 65081096 CDM 278 RC facility both 5332 5332 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA SYMMETRIC SZ S36MM X 10MM 65081096 CDM 278 RC facility both 5332 5332 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASEPLATE UNIVERSAL SZ 6 65081097 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASEPLATE UNIVERSAL SZ 6 65081097 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 4HL SHORT BARREL 6508111 CDM 278 RC facility both 1578 1578 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 4HL SHORT BARREL 6508111 CDM 278 RC facility both 1578 1578 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 3HL SHORT BARREL 6508112 CDM 278 RC facility both 2001 2001 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 3HL SHORT BARREL 6508112 CDM 278 RC facility both 2001 2001 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 2HL SHORT BARREL 6508113 CDM 278 RC facility both 1950 1950 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 2HL SHORT BARREL 6508113 CDM 278 RC facility both 1950 1950 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 3HL SHORT BARREL 6508114 CDM 278 RC facility both 2973 2973 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 3HL SHORT BARREL 6508114 CDM 278 RC facility both 2973 2973 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 4HL SHORT BARREL 6508115 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 4HL SHORT BARREL 6508115 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 12 STANDARD 6508117 CDM 278 RC facility both 15256 15256 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 12 STANDARD 6508117 CDM 278 RC facility both 15256 15256 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 2HL STAND BARREL 6508118 CDM 278 RC facility both 1950 1950 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 2HL STAND BARREL 6508118 CDM 278 RC facility both 1950 1950 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 3HL STAND BARREL 6508119 CDM 278 RC facility both 1578 1578 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 3HL STAND BARREL 6508119 CDM 278 RC facility both 1578 1578 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 4HL STAND BARREL 6508120 CDM 278 RC facility both 1452 1452 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 4HL STAND BARREL 6508120 CDM 278 RC facility both 1452 1452 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 6HL STAND BARREL 6508121 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 130 DEG X 6HL STAND BARREL 6508121 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PERMACOL .15X20X1.00 65081236 CDM 278 RC facility both 21036 21036 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PERMACOL .15X20X1.00 65081236 CDM 278 RC facility both 21036 21036 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 13 STANDARD 6508124 CDM 278 RC facility both 1452 1452 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 13 STANDARD 6508124 CDM 278 RC facility both 1452 1452 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 3HL STAND BARREL 6508125 CDM 278 RC facility both 1655 1655 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 3HL STAND BARREL 6508125 CDM 278 RC facility both 1655 1655 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 4HL STAND BARREL 6508126 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 4HL STAND BARREL 6508126 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 6HL STAND BARREL 6508127 CDM 278 RC facility both 1428 1428 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 6HL STAND BARREL 6508127 CDM 278 RC facility both 1428 1428 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 4HL STAND BARREL 6508130 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 4HL STAND BARREL 6508130 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 5HL STAND BARREL 6508131 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 5HL STAND BARREL 6508131 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 6HL STAND BARREL 6508133 CDM 278 RC facility both 2429 2429 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 6HL STAND BARREL 6508133 CDM 278 RC facility both 2429 2429 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 145 DEG X 4HL STAND BARREL 6508134 CDM 278 RC facility both 1578 1578 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 145 DEG X 4HL STAND BARREL 6508134 CDM 278 RC facility both 1578 1578 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 145 DEG X 5HL STAND BARREL 6508135 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 145 DEG X 5HL STAND BARREL 6508135 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 145 DEG X 6HL STAND BARREL 6508137 CDM 278 RC facility both 2429 2429 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 145 DEG X 6HL STAND BARREL 6508137 CDM 278 RC facility both 2429 2429 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 150 DEG X 4HL STAND BARREL 6508138 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 150 DEG X 4HL STAND BARREL 6508138 CDM 278 RC facility both 1338 1338 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE TROCH STAB 138MM 6508147 CDM facility both 1407 1407 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE TROCH STAB 138MM 6508147 CDM facility both 1407 1407 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE TROCH STAB 148MM 6508148 CDM facility both 1407 1407 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE TROCH STAB 148MM 6508148 CDM facility both 1407 1407 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW COMPRESSING DHS DCS 6508149 CDM 278 RC facility both 246 246 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW COMPRESSING DHS DCS 6508149 CDM 278 RC facility both 246 246 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 65MM 6508153 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 65MM 6508153 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 70MM 6508154 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 70MM 6508154 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 75MM 6508155 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 75MM 6508155 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 80MM 6508156 CDM 278 RC facility both 1247 1247 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 80MM 6508156 CDM 278 RC facility both 1247 1247 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHC DCS LAG ONE STEP 85MM 6508157 CDM 278 RC facility both 1247 1247 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHC DCS LAG ONE STEP 85MM 6508157 CDM 278 RC facility both 1247 1247 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 90MM 6508158 CDM 278 RC facility both 1247 1247 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 90MM 6508158 CDM 278 RC facility both 1247 1247 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 95MM 6508159 CDM 278 RC facility both 1779 1779 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 95MM 6508159 CDM 278 RC facility both 1779 1779 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 100MM 6508160 CDM 278 RC facility both 1905 1905 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 100MM 6508160 CDM 278 RC facility both 1905 1905 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 105MM 6508161 CDM 278 RC facility both 1905 1905 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 105MM 6508161 CDM 278 RC facility both 1905 1905 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 110MM 6508162 CDM 278 RC facility both 2081 2081 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 110MM 6508162 CDM 278 RC facility both 2081 2081 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 115MM 6508163 CDM 278 RC facility both 1551 1551 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 115MM 6508163 CDM 278 RC facility both 1551 1551 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 120MM 6508164 CDM 278 RC facility both 1551 1551 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 120MM 6508164 CDM 278 RC facility both 1551 1551 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 130MM 6508165 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 130MM 6508165 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE PIN THR DHS 2.5X230MM 6508169 CDM 272 RC facility both 179 179 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE PIN THR DHS 2.5X230MM 6508169 CDM 272 RC facility both 179 179 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 125MM 6508172 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW DHS DCS LAG ONE STEP 125MM 6508172 CDM 278 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 2HL SHORT BARREL 6508173 CDM 278 RC facility both 2973 2973 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 2HL SHORT BARREL 6508173 CDM 278 RC facility both 2973 2973 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT HYDROSET STRYKER 65082005 CDM 278 RC facility both 8926 8926 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT HYDROSET STRYKER 65082005 CDM 278 RC facility both 8926 8926 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE BUTTON COCR 1.8MM X 635MM 65082016 CDM 278 RC facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE BUTTON COCR 1.8MM X 635MM 65082016 CDM 278 RC facility both 1809 1809 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X45MMv 65082025 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X45MMv 65082025 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 14 FMMC STANDAR 6508203 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 14 FMMC STANDAR 6508203 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X30MM 65082033 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X30MM 65082033 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36MM 623-00-36D 65082037 CDM 278 RC facility both 8795 8795 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36MM 623-00-36D 65082037 CDM 278 RC facility both 8795 8795 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MMX30MM 65082038 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MMX30MM 65082038 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 36MM OD 65082039 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 36MM OD 65082039 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 52MM SIZE II 6508204 CDM 278 RC facility both 13570 13570 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 52MM SIZE II 6508204 CDM 278 RC facility both 13570 13570 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 50 MM D 65082040 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 50 MM D 65082040 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SIMPLEX P WITH TOBRAMYCIN CEMENT 10/PK 65082044 CDM 278 RC facility both 1782 1782 Gross Charge Type: NIHD_Hosp_Profee_Price SIMPLEX P WITH TOBRAMYCIN CEMENT 10/PK 65082044 CDM 278 RC facility both 1782 1782 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASEPLATE UNIVERSAL SZ 7 65082045 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASEPLATE UNIVERSAL SZ 7 65082045 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 7 RIGHT 5510-F-701 65082046 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 7 RIGHT 5510-F-701 65082046 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 7X11MM 65082047 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 7X11MM 65082047 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 6X16 MM 65082048 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 6X16 MM 65082048 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE II 6508205 CDM 278 RC facility both 7190 7190 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE II 6508205 CDM 278 RC facility both 7190 7190 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR BLUE /C-H 14MM 00597605014 65082055 CDM 278 RC facility both 5218 5218 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR BLUE /C-H 14MM 00597605014 65082055 CDM 278 RC facility both 5218 5218 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM 12/14 TAPER SZ 4 STD 103MM 65082056 CDM 278 RC facility both 27749 27749 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM 12/14 TAPER SZ 4 STD 103MM 65082056 CDM 278 RC facility both 27749 27749 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT SZ 36MM VIVACIT 65082057 CDM 278 RC facility both 9976 9976 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT SZ 36MM VIVACIT 65082057 CDM 278 RC facility both 9976 9976 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE II VIVACIT-E 65082058 CDM 278 RC facility both 14842 14842 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE II VIVACIT-E 65082058 CDM 278 RC facility both 14842 14842 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE SCREWDRIVER 1-10 180MM 65082063 CDM 278 RC facility both 1112 1112 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE SCREWDRIVER 1-10 180MM 65082063 CDM 278 RC facility both 1112 1112 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT TIBIALIS TENDON ANTERIOR 65082068 CDM 278 RC facility both 3044 3044 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT TIBIALIS TENDON ANTERIOR 65082068 CDM 278 RC facility both 3044 3044 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE JJ 6508207 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE JJ 6508207 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.2X260MM AO STRYKER1806-4250S 65082073 CDM 272 RC facility both 858 858 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.2X260MM AO STRYKER1806-4250S 65082073 CDM 272 RC facility both 858 858 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 03X285MM STRYKER 65082075 CDM 272 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 03X285MM STRYKER 65082075 CDM 272 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP NECK +0MM 6508208 CDM 278 RC facility both 4767 4767 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP NECK +0MM 6508208 CDM 278 RC facility both 4767 4767 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5MMX30MM CENTRAL 65082094 CDM 278 RC facility both 711 711 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5MMX30MM CENTRAL 65082094 CDM 278 RC facility both 711 711 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 8X122 MM LONG 65082095 CDM 278 RC facility both 17034 17034 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 8X122 MM LONG 65082095 CDM 278 RC facility both 17034 17034 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5MM HEX 4.75X30 MM 65082096 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5MM HEX 4.75X30 MM 65082096 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE KK VIVACIT-E 00885201236 65082097 CDM 278 RC facility both 9592 9592 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT 36MM SIZE KK VIVACIT-E 00885201236 65082097 CDM 278 RC facility both 9592 9592 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 4.75X35 MM 65082098 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 4.75X35 MM 65082098 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price REV HUMERAL BEARING 44X36MM CURVED 65082099 CDM 278 RC facility both 5218 5218 Gross Charge Type: NIHD_Hosp_Profee_Price REV HUMERAL BEARING 44X36MM CURVED 65082099 CDM 278 RC facility both 5218 5218 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 7.5 6508210 CDM 278 RC facility both 23930 23930 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 7.5 6508210 CDM 278 RC facility both 23930 23930 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5MM HEX 4.75X15MM 65082100 CDM 278 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5MM HEX 4.75X15MM 65082100 CDM 278 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X330MM 65082103 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X330MM 65082103 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X330MM 65082104 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X330MM 65082104 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X255MM 65082105 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X255MM 65082105 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X300MM 65082106 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X300MM 65082106 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X270MM 65082107 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X270MM 65082107 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X285MM 65082108 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X285MM 65082108 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X315MM 65082109 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X315MM 65082109 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 16 COATED EXT N 6508211 CDM 278 RC facility both 23776 23776 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 16 COATED EXT N 6508211 CDM 278 RC facility both 23776 23776 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X345MM 65082110 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X345MM 65082110 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X360MM 65082111 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X360MM 65082111 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X375MM 65082112 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X375MM 65082112 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X390MM 65082113 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X390MM 65082113 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X270MM 65082114 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X270MM 65082114 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X285MM 65082115 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X285MM 65082115 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X300MM 65082116 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X300MM 65082116 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X315MM 65082117 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X315MM 65082117 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X345MM 65082118 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X345MM 65082118 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X390MM 65082119 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X390MM 65082119 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X285MM 65082120 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X285MM 65082120 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X300MM 65082121 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X300MM 65082121 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X315MM 65082122 CDM 278 RC facility both 6417 6417 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X315MM 65082122 CDM 278 RC facility both 6417 6417 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X345MM 65082123 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X345MM 65082123 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X360MM 65082124 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X360MM 65082124 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X375MM 65082125 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X375MM 65082125 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X390MM 65082126 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X390MM 65082126 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X405MM 65082127 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 10X405MM 65082127 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X285MM 65082128 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X285MM 65082128 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X300MM 65082129 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X300MM 65082129 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X315MM 65082130 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X315MM 65082130 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X330MM 65082131 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X330MM 65082131 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X345MM 65082132 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X345MM 65082132 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X360MM 65082133 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X360MM 65082133 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X375MM 65082134 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X375MM 65082134 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X390MM 65082135 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X390MM 65082135 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X405MM 65082136 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X405MM 65082136 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X420MM 65082137 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 11X420MM 65082137 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X285MM 65082138 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X285MM 65082138 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X300MM 65082139 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X300MM 65082139 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X315MM 65082140 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X315MM 65082140 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X330MM 65082145 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X330MM 65082145 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X345MM 65082146 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X345MM 65082146 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X360MM 65082147 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X360MM 65082147 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X375MM 65082148 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X375MM 65082148 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X390MM 65082149 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X390MM 65082149 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X405MM 65082150 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X405MM 65082150 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X435MM 65082151 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 12X435MM 65082151 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 5 LEFT 65082154 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 5 LEFT 65082154 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3 X 9 MM 65082156 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3 X 9 MM 65082156 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASEPLATE UNIVERSAL SZ 3 65082157 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASEPLATE UNIVERSAL SZ 3 65082157 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 3 LEFT 65082158 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 3 LEFT 65082158 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 32MM 18-3205 65082159 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 32MM 18-3205 65082159 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER 40MM 64 SHELL 3.5OFFSET 6508216 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER 40MM 64 SHELL 3.5OFFSET 6508216 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32MM 623-00-32C 65082160 CDM 278 RC facility both 8051 8051 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32MM 623-00-32C 65082160 CDM 278 RC facility both 8051 8051 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MM X25MM 65082161 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MM X25MM 65082161 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 48 MM C 65082162 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 48 MM C 65082162 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price MODULAR HEAD 42X18X46MM TOT SHOULDER 65082178 CDM 278 RC facility both 9115 9115 Gross Charge Type: NIHD_Hosp_Profee_Price MODULAR HEAD 42X18X46MM TOT SHOULDER 65082178 CDM 278 RC facility both 9115 9115 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA SYMMETRIC SZ S33MM X 9MM 65082179 CDM 278 RC facility both 5176 5176 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA SYMMETRIC SZ S33MM X 9MM 65082179 CDM 278 RC facility both 5176 5176 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 5X16MM 65082180 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 5X16MM 65082180 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASE PLATE UNIVERSAL SZ 5 65082182 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASE PLATE UNIVERSAL SZ 5 65082182 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASEPLATE UNIVERSAL SZ 1 65082183 CDM 278 RC facility both 12539 12539 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASEPLATE UNIVERSAL SZ 1 65082183 CDM 278 RC facility both 12539 12539 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMP STABLIZER SZ 2 LEFT 65082184 CDM 278 RC facility both 31077 31077 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMP STABLIZER SZ 2 LEFT 65082184 CDM 278 RC facility both 31077 31077 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL DISTAL AUGMENT SZ 2X15MM LFT 65082185 CDM 278 RC facility both 6108 6108 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL DISTAL AUGMENT SZ 2X15MM LFT 65082185 CDM 278 RC facility both 6108 6108 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR AUGMENT SZ 2X5MM 65082186 CDM 278 RC facility both 5773 5773 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR AUGMENT SZ 2X5MM 65082186 CDM 278 RC facility both 5773 5773 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR AUGMENT SZ 2X10MM 65082187 CDM 278 RC facility both 5773 5773 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR AUGMENT SZ 2X10MM 65082187 CDM 278 RC facility both 5773 5773 Gross Charge Type: NIHD_Hosp_Profee_Price STEM FLUTED 12MMX100MM 65082188 CDM 278 RC facility both 6127 6127 Gross Charge Type: NIHD_Hosp_Profee_Price STEM FLUTED 12MMX100MM 65082188 CDM 278 RC facility both 6127 6127 Gross Charge Type: NIHD_Hosp_Profee_Price TIBLIAL INSERT TOTAL STABILIZER SZ 1X22M 65082189 CDM 278 RC facility both 11697 11697 Gross Charge Type: NIHD_Hosp_Profee_Price TIBLIAL INSERT TOTAL STABILIZER SZ 1X22M 65082189 CDM 278 RC facility both 11697 11697 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 38MM DIAMETER 6508219 CDM 278 RC facility both 5037 5037 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 38MM DIAMETER 6508219 CDM 278 RC facility both 5037 5037 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL DISTAL AUGMENT-LEFT SZ 2X5MM 65082190 CDM 278 RC facility both 5541 5541 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL DISTAL AUGMENT-LEFT SZ 2X5MM 65082190 CDM 278 RC facility both 5541 5541 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTOR OFFSET SZ 6MM 65082191 CDM 278 RC facility both 25027 25027 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTOR OFFSET SZ 6MM 65082191 CDM 278 RC facility both 25027 25027 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE MTP LEFT LONG 65082193 CDM 278 RC facility both 3428 3428 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE MTP LEFT LONG 65082193 CDM 278 RC facility both 3428 3428 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING 3.0X14MM ARTHREX 65082194 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING 3.0X14MM ARTHREX 65082194 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING 3.0X16MM ARTHREX 65082195 CDM 278 RC facility both 95 95 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING 3.0X16MM ARTHREX 65082195 CDM 278 RC facility both 95 95 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING 3.0X18MM ARTHREX 65082196 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING 3.0X18MM ARTHREX 65082196 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.0X16MM ARTHREX 65082197 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.0X16MM ARTHREX 65082197 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.0X18MM ARTHREX 65082198 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.0X18MM ARTHREX 65082198 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.0X22MM ARTHREX 65082199 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.0X22MM ARTHREX 65082199 CDM 278 RC facility both 475 475 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 3.0X32MM ARTHREX 65082200 CDM 278 RC facility both 516 516 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW PART THREADED 3.0X32MM ARTHREX 65082200 CDM 278 RC facility both 516 516 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE 1.1MM ARTHREX 65082202 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE 1.1MM ARTHREX 65082202 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 56MM SIZE KK MULTIHL 65082203 CDM 278 RC facility both 14386 14386 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 56MM SIZE KK MULTIHL 65082203 CDM 278 RC facility both 14386 14386 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3X11 MM 65082204 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3X11 MM 65082204 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 5 RIGHT 65082213 CDM 278 RC facility both 14992 14992 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 5 RIGHT 65082213 CDM 278 RC facility both 14992 14992 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 5X11MM 65082214 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 5X11MM 65082214 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM SIZE 14 FMMC STAND LM BODY 65082215 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM SIZE 14 FMMC STAND LM BODY 65082215 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 58MM SIZE LL 65082216 CDM 278 RC facility both 13570 13570 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 58MM SIZE LL 65082216 CDM 278 RC facility both 13570 13570 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2 X145MM THREE FLUTED 65082219 CDM 272 RC facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2 X145MM THREE FLUTED 65082219 CDM 272 RC facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 7 NEXGEN 6508222 CDM 278 RC facility both 10494 10494 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 7 NEXGEN 6508222 CDM 278 RC facility both 10494 10494 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 2.5X285MM TROCAR POINT 65082220 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 2.5X285MM TROCAR POINT 65082220 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price MULTIPOLAR BIOPOLAR CUP SHELL 45MM 65082227 CDM facility both 1113 1113 Gross Charge Type: NIHD_Hosp_Profee_Price MULTIPOLAR BIOPOLAR CUP SHELL 45MM 65082227 CDM facility both 1113 1113 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 14 EXT NECK 65082228 CDM 278 RC facility both 22683 22683 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 14 EXT NECK 65082228 CDM 278 RC facility both 22683 22683 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT SIZE G- CR-FLEX RIGHT 6508223 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT SIZE G- CR-FLEX RIGHT 6508223 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 6 NEXGEN 6508224 CDM 278 RC facility both 9994 9994 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 6 NEXGEN 6508224 CDM 278 RC facility both 9994 9994 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR GREEN/C-H 10MM 6508225 CDM 278 RC facility both 7556 7556 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR GREEN/C-H 10MM 6508225 CDM 278 RC facility both 7556 7556 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 5 NEXGEN 6508226 CDM 278 RC facility both 10704 10704 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 5 NEXGEN 6508226 CDM 278 RC facility both 10704 10704 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 15 FULLCOAT 6508227 CDM facility both 29293 29293 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 15 FULLCOAT 6508227 CDM facility both 29293 29293 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX VOLAR LEFT INTERM SHORT 65082285 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX VOLAR LEFT INTERM SHORT 65082285 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX VOLAR LEFT INTERMED SHORT 65082288 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX VOLAR LEFT INTERMED SHORT 65082288 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX VOLAR RT INTER EX SHORT 65082289 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX VOLAR RT INTER EX SHORT 65082289 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX F- LEFT 6508230 CDM 278 RC facility both 21678 21678 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX F- LEFT 6508230 CDM 278 RC facility both 21678 21678 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL HEAD 26.0MM LEFT 65082300 CDM 278 RC facility both 10258 10258 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL HEAD 26.0MM LEFT 65082300 CDM 278 RC facility both 10258 10258 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL STEM 10.0X 0.0MM 65082301 CDM 278 RC facility both 6246 6246 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL STEM 10.0X 0.0MM 65082301 CDM 278 RC facility both 6246 6246 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX LEFT DORSAL WIDE 81MM 65082306 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX LEFT DORSAL WIDE 81MM 65082306 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR GREEN/C-H 12MM 6508231 CDM 278 RC facility both 7058 7058 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR GREEN/C-H 12MM 6508231 CDM 278 RC facility both 7058 7058 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX LEFT DORSAL STD 81MM 65082310 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX LEFT DORSAL STD 81MM 65082310 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3X13 MM 65082312 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3X13 MM 65082312 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 3 RIGHT 65082313 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 3 RIGHT 65082313 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3X16MM 65082314 CDM 278 RC facility both 8552 8552 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3X16MM 65082314 CDM 278 RC facility both 8552 8552 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MMX20MM 65082315 CDM 278 RC facility both 587 587 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MMX20MM 65082315 CDM 278 RC facility both 587 587 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER L-FIT SZ 32X0MM 65082316 CDM 278 RC facility both 8759 8759 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER L-FIT SZ 32X0MM 65082316 CDM 278 RC facility both 8759 8759 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX F- RIGHT 6508232 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX F- RIGHT 6508232 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 13 STANDARD 6508233 CDM 278 RC facility both 24106 24106 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 13 STANDARD 6508233 CDM 278 RC facility both 24106 24106 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX ST 8MM 65082331 CDM 278 RC facility both 3178 3178 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX ST 8MM 65082331 CDM 278 RC facility both 3178 3178 Gross Charge Type: NIHD_Hosp_Profee_Price MODULAR HEAD 50MM X 21MM X57MM 65082335 CDM 278 RC facility both 7866 7866 Gross Charge Type: NIHD_Hosp_Profee_Price MODULAR HEAD 50MM X 21MM X57MM 65082335 CDM 278 RC facility both 7866 7866 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX 6.4CM 65082341 CDM 278 RC facility both 3338 3338 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX 6.4CM 65082341 CDM 278 RC facility both 3338 3338 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 2 RIGHT 65082345 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 2 RIGHT 65082345 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 35MM DIAMETER 6508235 CDM 278 RC facility both 5158 5158 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 35MM DIAMETER 6508235 CDM 278 RC facility both 5158 5158 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX F RIGHT 6508236 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX F RIGHT 6508236 CDM 278 RC facility both 19999 19999 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD BIOLOX 36MM/-3.5 S12/14TAPE 6508237 CDM facility both 8875 8875 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD BIOLOX 36MM/-3.5 S12/14TAPE 6508237 CDM facility both 8875 8875 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X25MM 6508239 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X25MM 6508239 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE NN 6508240 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE NN 6508240 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 15 65082400 CDM 278 RC facility both 22683 22683 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 15 65082400 CDM 278 RC facility both 22683 22683 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36E 65082401 CDM 278 RC facility both 8539 8539 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36E 65082401 CDM 278 RC facility both 8539 8539 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER L-FIT SZ 36X7.5MM 65082402 CDM 278 RC facility both 8759 8759 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER L-FIT SZ 36X7.5MM 65082402 CDM 278 RC facility both 8759 8759 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 56 MM E 65082403 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 56 MM E 65082403 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 7 RIGHT 5510-F-702 65082408 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 7 RIGHT 5510-F-702 65082408 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE LOCK 2.7X14MM TOREX 65082413 CDM 278 RC facility both 616 616 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE LOCK 2.7X14MM TOREX 65082413 CDM 278 RC facility both 616 616 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR SIZE H RIGHT 6508242 CDM 278 RC facility both 13570 13570 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR SIZE H RIGHT 6508242 CDM 278 RC facility both 13570 13570 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR BLUE/C-H 10MM 6508243 CDM 278 RC facility both 7646 7646 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR BLUE/C-H 10MM 6508243 CDM 278 RC facility both 7646 7646 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX E LEFT 6508244 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX E LEFT 6508244 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MMX16MM 65082449 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MMX16MM 65082449 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 2HL SHORT BARREL 6508245 CDM 278 RC facility both 2141 2141 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 2HL SHORT BARREL 6508245 CDM 278 RC facility both 2141 2141 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 54MM E 65082450 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 54MM E 65082450 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CENTRAL RVS 6.5X20MM 65082454 CDM 278 RC facility both 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CENTRAL RVS 6.5X20MM 65082454 CDM 278 RC facility both 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5MM HEX 4.75X25MM 65082455 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5MM HEX 4.75X25MM 65082455 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW FIXED LOCK RVS 4.75X20X3.5MM 65082458 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW FIXED LOCK RVS 4.75X20X3.5MM 65082458 CDM 278 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 36MM +0 65082459 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAPER CERAMIC SZ 36MM +0 65082459 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 2HL STAND BARREL 6508246 CDM 278 RC facility both 2429 2429 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 135 DEG X 2HL STAND BARREL 6508246 CDM 278 RC facility both 2429 2429 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 2HL STAND BARREL 6508247 CDM 278 RC facility both 3500 3500 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DHS 140 DEG X 2HL STAND BARREL 6508247 CDM 278 RC facility both 3500 3500 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL CERAMIC V40 SZ 28MM +0MM 65082480 CDM 278 RC facility both 8594 8594 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL CERAMIC V40 SZ 28MM +0MM 65082480 CDM 278 RC facility both 8594 8594 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT RESTORATION SIZE 28/48 SIZE 42E 65082481 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT RESTORATION SIZE 28/48 SIZE 42E 65082481 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price LINER MDM SIZE ID 42MM E 65082482 CDM 278 RC facility both 10419 10419 Gross Charge Type: NIHD_Hosp_Profee_Price LINER MDM SIZE ID 42MM E 65082482 CDM 278 RC facility both 10419 10419 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE KK 6508250 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE KK 6508250 CDM 278 RC facility both 6866 6866 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 44MM VERSYS 65082500 CDM facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 44MM VERSYS 65082500 CDM facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 13 FMMC STANDAR 6508251 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 13 FMMC STANDAR 6508251 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP 36MM +7.0MM 65082519 CDM 278 RC facility both 3836 3836 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP 36MM +7.0MM 65082519 CDM 278 RC facility both 3836 3836 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 56MM SIZE KK 6508252 CDM 278 RC facility both 10234 10234 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 56MM SIZE KK 6508252 CDM 278 RC facility both 10234 10234 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR DOME/SCREW HOLE PLUG 00875700003 6508253 CDM 278 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR DOME/SCREW HOLE PLUG 00875700003 6508253 CDM 278 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT DERMIS (LIFE NET) 4.0X7.0CM 65082541 CDM 278 RC facility both 11835 11835 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT DERMIS (LIFE NET) 4.0X7.0CM 65082541 CDM 278 RC facility both 11835 11835 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CENTRAL RVS 6.5X35MM 65082547 CDM 278 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CENTRAL RVS 6.5X35MM 65082547 CDM 278 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERAL FRACTURE STEM 8MM 11-113558 65082548 CDM 278 RC facility both 19115 19115 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERAL FRACTURE STEM 8MM 11-113558 65082548 CDM 278 RC facility both 19115 19115 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE GLENOSPHERE 36MM HUMERAL BEARING 115316 65082549 CDM 278 RC facility both 7322 7322 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE GLENOSPHERE 36MM HUMERAL BEARING 115316 65082549 CDM 278 RC facility both 7322 7322 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X13MM 65082587 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X13MM 65082587 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 41 MM 6508262 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 41 MM 6508262 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR AC GREEN 10MM 00597604010 6508263 CDM 278 RC facility both 5878 5878 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR AC GREEN 10MM 00597604010 6508263 CDM 278 RC facility both 5878 5878 Gross Charge Type: NIHD_Hosp_Profee_Price AUGMENT BLOCK 5MM SIZE D DIST FEMORAL 6508266 CDM facility both 8816 8816 Gross Charge Type: NIHD_Hosp_Profee_Price AUGMENT BLOCK 5MM SIZE D DIST FEMORAL 6508266 CDM facility both 8816 8816 Gross Charge Type: NIHD_Hosp_Profee_Price AUGMENT BLOCK 5MM SIZE D POST FEMORAL 6508267 CDM facility both 8816 8816 Gross Charge Type: NIHD_Hosp_Profee_Price AUGMENT BLOCK 5MM SIZE D POST FEMORAL 6508267 CDM facility both 8816 8816 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 6 65082687 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 6 65082687 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE LL 6508270 CDM 278 RC facility both 7005 7005 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE LL 6508270 CDM 278 RC facility both 7005 7005 Gross Charge Type: NIHD_Hosp_Profee_Price STEM FEMORAL SZ 10MM STANDARD 65082701 CDM 278 RC facility both 6417 6417 Gross Charge Type: NIHD_Hosp_Profee_Price STEM FEMORAL SZ 10MM STANDARD 65082701 CDM 278 RC facility both 6417 6417 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 54MM SIZE JJ MULTI HOLE 6508274 CDM 278 RC facility both 14386 14386 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 54MM SIZE JJ MULTI HOLE 6508274 CDM 278 RC facility both 14386 14386 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 32MM SIZE JJ 6508275 CDM facility both 5548 5548 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 32MM SIZE JJ 6508275 CDM facility both 5548 5548 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X15MM 6508276 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X15MM 6508276 CDM 278 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 12 STANDARD 6508278 CDM 278 RC facility both 27344 27344 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM TRABECULAR SIZE 12 STANDARD 6508278 CDM 278 RC facility both 27344 27344 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL AUGMENT HALF BLOCK 65082785 CDM 278 RC facility both 13155 13155 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL AUGMENT HALF BLOCK 65082785 CDM 278 RC facility both 13155 13155 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X40MM - DEPUY 65082788 CDM 278 RC facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price CANCELLOUS BONE SCREW 6.5X40MM - DEPUY 65082788 CDM 278 RC facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X20MM 6508279 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X20MM 6508279 CDM 278 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price NECK MODULAR KINECTIV SIZE G 6508280 CDM 278 RC facility both 6678 6678 Gross Charge Type: NIHD_Hosp_Profee_Price NECK MODULAR KINECTIV SIZE G 6508280 CDM 278 RC facility both 6678 6678 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 5X9MM 65082814 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 5X9MM 65082814 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE JJ 6508282 CDM 278 RC facility both 7190 7190 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER ELEVATED 36MM SIZE JJ 6508282 CDM 278 RC facility both 7190 7190 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 12 FMMC STANDAR 6508283 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 12 FMMC STANDAR 6508283 CDM 278 RC facility both 24436 24436 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL STEM 10.0X2.0MM 6508286 CDM 278 RC facility both 6246 6246 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL STEM 10.0X2.0MM 6508286 CDM 278 RC facility both 6246 6246 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 12.5 6508288 CDM 278 RC facility both 20900 20900 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM KINECTIV SIZE 12.5 6508288 CDM 278 RC facility both 20900 20900 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 12 FMMC STD/STD 6508292 CDM 278 RC facility both 21797 21797 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 12 FMMC STD/STD 6508292 CDM 278 RC facility both 21797 21797 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 52 MM D 65082954 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL HEMI CLUSTER HOLE SZ 52 MM D 65082954 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price LINER CEMENTLESS 38MM D 65082955 CDM 278 RC facility both 10419 10419 Gross Charge Type: NIHD_Hosp_Profee_Price LINER CEMENTLESS 38MM D 65082955 CDM 278 RC facility both 10419 10419 Gross Charge Type: NIHD_Hosp_Profee_Price LINER INSERT MDM 22.2MMX38MM 38D 65082956 CDM 278 RC facility both 7969 7969 Gross Charge Type: NIHD_Hosp_Profee_Price LINER INSERT MDM 22.2MMX38MM 38D 65082956 CDM 278 RC facility both 7969 7969 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP 132 NECK ANGLE V40 65082957 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP 132 NECK ANGLE V40 65082957 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL CERAMIC V40 SZ 22.2MM +0MM 65082958 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL CERAMIC V40 SZ 22.2MM +0MM 65082958 CDM 278 RC facility both 3946 3946 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE CERCLAGE WITH CRIMP 1.8MMX36MM 65082987 CDM 278 RC facility both 2085 2085 Gross Charge Type: NIHD_Hosp_Profee_Price CABLE CERCLAGE WITH CRIMP 1.8MMX36MM 65082987 CDM 278 RC facility both 2085 2085 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 52MM SIZE II MULTI-HOLE 65083010 CDM 278 RC facility both 10234 10234 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 52MM SIZE II MULTI-HOLE 65083010 CDM 278 RC facility both 10234 10234 Gross Charge Type: NIHD_Hosp_Profee_Price ACUTE AC REPAIR IMPLANT SYSTEM (DOGBONE) 65083154 CDM 278 RC facility both 3374 3374 Gross Charge Type: NIHD_Hosp_Profee_Price ACUTE AC REPAIR IMPLANT SYSTEM (DOGBONE) 65083154 CDM 278 RC facility both 3374 3374 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS CEMENT 11X120MM 65083400 CDM 278 RC facility both 6836 6836 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS CEMENT 11X120MM 65083400 CDM 278 RC facility both 6836 6836 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX G- LEFT GSF 65083403 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX G- LEFT GSF 65083403 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 6 RIGHT 65083405 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 6 RIGHT 65083405 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 LFT 65083500 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 LFT 65083500 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price RIA LOCKING CLIP - STERILE 65084009 CDM 272 RC facility both 354 354 Gross Charge Type: NIHD_Hosp_Profee_Price RIA LOCKING CLIP - STERILE 65084009 CDM 272 RC facility both 354 354 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CANCELLOUS CUBES 4-10MM 15CC FD 6508403 CDM 278 RC facility both 1104 1104 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CANCELLOUS CUBES 4-10MM 15CC FD 6508403 CDM 278 RC facility both 1104 1104 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF F RIGHT 6508411 CDM 278 RC facility both 22139 22139 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX GSF F RIGHT 6508411 CDM 278 RC facility both 22139 22139 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP VOLAR DIST RAD 9X3HL LT 6508419 CDM facility both 2445 2445 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP VOLAR DIST RAD 9X3HL LT 6508419 CDM facility both 2445 2445 Gross Charge Type: NIHD_Hosp_Profee_Price BONE FILLER SPONGE 5CC COPIOS 6508425 CDM 278 RC facility both 3554 3554 Gross Charge Type: NIHD_Hosp_Profee_Price BONE FILLER SPONGE 5CC COPIOS 6508425 CDM 278 RC facility both 3554 3554 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA SYMMETRIC SZ S31MM X 9MM 65084258 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA SYMMETRIC SZ S31MM X 9MM 65084258 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price BONE FILLER PASTE 5CC COPIOS 6508427 CDM 278 RC facility both 3928 3928 Gross Charge Type: NIHD_Hosp_Profee_Price BONE FILLER PASTE 5CC COPIOS 6508427 CDM 278 RC facility both 3928 3928 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 1.0MM TROCAR SINGLE PT 6508430 CDM 278 RC facility both 436 436 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 1.0MM TROCAR SINGLE PT 6508430 CDM 278 RC facility both 436 436 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 1.6MM TROCAR DBLE PT 6508438 CDM 278 RC facility both 627 627 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 1.6MM TROCAR DBLE PT 6508438 CDM 278 RC facility both 627 627 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 2.0MM TROCAR DBLE PT 6508439 CDM 278 RC facility both 478 478 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 2.0MM TROCAR DBLE PT 6508439 CDM 278 RC facility both 478 478 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X10MM STAR DRIVE 6508441 CDM 278 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X10MM STAR DRIVE 6508441 CDM 278 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X14MM STAR DRIVE 6508443 CDM 278 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X14MM STAR DRIVE 6508443 CDM 278 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X16MM STAR DRIVE 6508444 CDM 278 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X16MM STAR DRIVE 6508444 CDM 278 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 2.0MM THD SINGLE PT 6508447 CDM 278 RC facility both 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 2.0MM THD SINGLE PT 6508447 CDM 278 RC facility both 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X18MM STAR DRIVE 6508451 CDM 278 RC facility both 172 172 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X18MM STAR DRIVE 6508451 CDM 278 RC facility both 172 172 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT SZ F LEFT CR-FLEX 65084512 CDM 278 RC facility both 22805 22805 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT SZ F LEFT CR-FLEX 65084512 CDM 278 RC facility both 22805 22805 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER ELEV 32MM SIZE HH VIVACIT-E 65084518 CDM 278 RC facility both 8057 8057 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER ELEV 32MM SIZE HH VIVACIT-E 65084518 CDM 278 RC facility both 8057 8057 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X20MM STAR DRIVE 6508452 CDM 278 RC facility both 172 172 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X20MM STAR DRIVE 6508452 CDM 278 RC facility both 172 172 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 1/3 TUBULAR 7HL 6508453 CDM facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 1/3 TUBULAR 7HL 6508453 CDM facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT JACKET 5X5CM 6508454 CDM facility both 7571 7571 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT JACKET 5X5CM 6508454 CDM facility both 7571 7571 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROGRIP SELF FIXATING 15CM X 10CM 65085001 CDM 278 RC facility both 1154 1154 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROGRIP SELF FIXATING 15CM X 10CM 65085001 CDM 278 RC facility both 1154 1154 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 6 X9MM 5531-G-609 65085124 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 6 X9MM 5531-G-609 65085124 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X8MM 6508520 CDM 278 RC facility both 409 409 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X8MM 6508520 CDM 278 RC facility both 409 409 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X10MM 6508521 CDM 278 RC facility both 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X10MM 6508521 CDM 278 RC facility both 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X12MM 6508522 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X12MM 6508522 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X14MM 6508523 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X14MM 6508523 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X16MM 6508524 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X16MM 6508524 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X18MM 6508525 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X18MM 6508525 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X20MM 6508526 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X20MM 6508526 CDM 278 RC facility both 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X22MM 6508527 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X22MM 6508527 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 6 X9MM 5530-G-609 65085417 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 6 X9MM 5530-G-609 65085417 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X24MM 6508550 CDM 278 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X24MM 6508550 CDM 278 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X26MM 6508551 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X26MM 6508551 CDM 278 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X28MM 6508552 CDM 278 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X28MM 6508552 CDM 278 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X30MM 6508553 CDM 278 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.7X30MM 6508553 CDM 278 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X56MM 6508556 CDM 278 RC facility both 402 402 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X56MM 6508556 CDM 278 RC facility both 402 402 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X58MM 6508557 CDM 278 RC facility both 402 402 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X58MM 6508557 CDM 278 RC facility both 402 402 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X55MM PART THD 6508558 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X55MM PART THD 6508558 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X60MM PART THD 6508559 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X60MM PART THD 6508559 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE MINI BASE PLATE GLENOSPHERE 25MM 65085645 CDM 278 RC facility both 7250 7250 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE MINI BASE PLATE GLENOSPHERE 25MM 65085645 CDM 278 RC facility both 7250 7250 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X54MM 6508568 CDM 278 RC facility both 520 520 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X54MM 6508568 CDM 278 RC facility both 520 520 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X42MM 6508602 CDM 278 RC facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X42MM 6508602 CDM 278 RC facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X44MM 6508603 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X44MM 6508603 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X46MM 6508604 CDM 278 RC facility both 502 502 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X46MM 6508604 CDM 278 RC facility both 502 502 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X48MM 6508605 CDM 278 RC facility both 502 502 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X48MM 6508605 CDM 278 RC facility both 502 502 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X52MM 6508606 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X52MM 6508606 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 6 X13MM 65086245 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CR SZ 6 X13MM 65086245 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 4 RIGHT 65086400 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 4 RIGHT 65086400 CDM 278 RC facility both 8995 8995 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD ADAPTER 7.0MM 6508641 CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD ADAPTER 7.0MM 6508641 CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC NARROW RT 6508642 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC NARROW RT 6508642 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC NARROW LT 6508643 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC NARROW LT 6508643 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS 15X140MM 6508650 CDM 278 RC facility both 7286 7286 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS 15X140MM 6508650 CDM 278 RC facility both 7286 7286 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 3.1 HUMERAL SET 65086505 CDM 272 RC facility both 593 593 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL 3.1 HUMERAL SET 65086505 CDM 272 RC facility both 593 593 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERAL FRACTURE STEM 8MM 12-113558 65086547 CDM 278 RC facility both 18845 18845 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERAL FRACTURE STEM 8MM 12-113558 65086547 CDM 278 RC facility both 18845 18845 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 41MM 6508655 CDM 278 RC facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 41MM 6508655 CDM 278 RC facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 45MM 6508660 CDM 278 RC facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 45MM 6508660 CDM 278 RC facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 47MM 6508663 CDM 278 RC facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 47MM 6508663 CDM 278 RC facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 49MM 6508664 CDM 278 RC facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 49MM 6508664 CDM 278 RC facility both 2361 2361 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 50MM 6508665 CDM 278 RC facility both 2324 2324 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 50MM 6508665 CDM 278 RC facility both 2324 2324 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 51MM 6508667 CDM 278 RC facility both 2069 2069 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 51MM 6508667 CDM 278 RC facility both 2069 2069 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 52MM 6508669 CDM 278 RC facility both 1245 1245 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 52MM 6508669 CDM 278 RC facility both 1245 1245 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 8 HOLE COMPRESSION BROAD STRYKER 65086962 CDM 278 RC facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 8 HOLE COMPRESSION BROAD STRYKER 65086962 CDM 278 RC facility both 974 974 Gross Charge Type: NIHD_Hosp_Profee_Price SCP KNEE KIT 65087001 CDM 278 RC facility both 12593 12593 Gross Charge Type: NIHD_Hosp_Profee_Price SCP KNEE KIT 65087001 CDM 278 RC facility both 12593 12593 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT PALACOS R+G 1X40 SINGLE (KNEE) 6508717 CDM 278 RC facility both 1919 1919 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT PALACOS R+G 1X40 SINGLE (KNEE) 6508717 CDM 278 RC facility both 1919 1919 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE MODHAND 0.8MM TROCAR SINGLE POINT 6508745 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE MODHAND 0.8MM TROCAR SINGLE POINT 6508745 CDM 278 RC facility both 378 378 Gross Charge Type: NIHD_Hosp_Profee_Price HEMI TIBIAL WEDGE SIZE 3-4 10MM 65087544 CDM 278 RC facility both 9611 9611 Gross Charge Type: NIHD_Hosp_Profee_Price HEMI TIBIAL WEDGE SIZE 3-4 10MM 65087544 CDM 278 RC facility both 9611 9611 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ 8X136MM V40 65088412 CDM 278 RC facility both 14288 14288 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ 8X136MM V40 65088412 CDM 278 RC facility both 14288 14288 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM+0 65088413 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM+0 65088413 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 10 DEGREE 36E 65088414 CDM 278 RC facility both 8795 8795 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 10 DEGREE 36E 65088414 CDM 278 RC facility both 8795 8795 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ9 34MM ANGLE V40 65088416 CDM 278 RC facility both 14288 14288 Gross Charge Type: NIHD_Hosp_Profee_Price HIP STEM 132DEG SZ9 34MM ANGLE V40 65088416 CDM 278 RC facility both 14288 14288 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL GUIDE THREADED 1.5MM 65088457 CDM 278 RC facility both 1883 1883 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL GUIDE THREADED 1.5MM 65088457 CDM 278 RC facility both 1883 1883 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X30MM STAR DRIVE 6508890 CDM 278 RC facility both 184 184 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTEX 2.7X30MM STAR DRIVE 6508890 CDM 278 RC facility both 184 184 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER 5515-F-301 65088954 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER 5515-F-301 65088954 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM MINI HUMERAL POR PLASMA 65089002 CDM 278 RC facility both 20809 20809 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM MINI HUMERAL POR PLASMA 65089002 CDM 278 RC facility both 20809 20809 Gross Charge Type: NIHD_Hosp_Profee_Price GLENOID HYBRID BASE 65089003 CDM 278 RC facility both 7976 7976 Gross Charge Type: NIHD_Hosp_Profee_Price GLENOID HYBRID BASE 65089003 CDM 278 RC facility both 7976 7976 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 3 NEXGEN 6508901 CDM 278 RC facility both 9895 9895 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 3 NEXGEN 6508901 CDM 278 RC facility both 9895 9895 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROGRIP SELF -GRIP POLYESTER 15X15M 65089147 CDM 278 RC facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROGRIP SELF -GRIP POLYESTER 15X15M 65089147 CDM 278 RC facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL LOCK 2.3X16MM ACCUMED 65089215 CDM 278 RC facility both 499 499 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL LOCK 2.3X16MM ACCUMED 65089215 CDM 278 RC facility both 499 499 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE NON-LOCK 3.5MMX14MM 65089261 CDM facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE NON-LOCK 3.5MMX14MM 65089261 CDM facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE NON-LOCK 3.5MMX16MM 65089262 CDM facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE NON-LOCK 3.5MMX16MM 65089262 CDM facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE LOCKING 3.5MMX14MM 65089265 CDM facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HEXALOBE LOCKING 3.5MMX14MM 65089265 CDM facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE LL 6508933 CDM 278 RC facility both 7190 7190 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE LL 6508933 CDM 278 RC facility both 7190 7190 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X35MM 6508935 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE SELF TAP 6.5X35MM 6508935 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MM X35MM 6508954 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE CANCELLEOUS 6.5MM X35MM 6508954 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE GLENOSPHERE 36MM HUMERAL BEARING 115375 65089564 CDM 278 RC facility both 8099 8099 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE GLENOSPHERE 36MM HUMERAL BEARING 115375 65089564 CDM 278 RC facility both 8099 8099 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP NECK -3.5MM 6508967 CDM 278 RC facility both 4888 4888 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL HEAD 36MM 12/14 TAP NECK -3.5MM 6508967 CDM 278 RC facility both 4888 4888 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX 8CM 65089745 CDM 278 RC facility both 2779 2779 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX 8CM 65089745 CDM 278 RC facility both 2779 2779 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC SHORT LT 6508978 CDM 278 RC facility both 4678 4678 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC SHORT LT 6508978 CDM 278 RC facility both 4678 4678 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROGRIP SELF -GRIP POLYESTER 15X9CM 65089841 CDM 278 RC facility both 970 970 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROGRIP SELF -GRIP POLYESTER 15X9CM 65089841 CDM 278 RC facility both 970 970 Gross Charge Type: NIHD_Hosp_Profee_Price DO NOT USE 65089843 CDM 278 RC facility both 1787 1787 Gross Charge Type: NIHD_Hosp_Profee_Price DO NOT USE 65089843 CDM 278 RC facility both 1787 1787 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 17X10CM 65089844 CDM 278 RC facility both 1314 1314 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 17X10CM 65089844 CDM 278 RC facility both 1314 1314 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 20X15CM 65089845 CDM 278 RC facility both 2905 2905 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 20X15CM 65089845 CDM 278 RC facility both 2905 2905 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 20X12CM 65089846 CDM 278 RC facility both 2125 2125 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 20X12CM 65089846 CDM 278 RC facility both 2125 2125 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 25X15CM 65089847 CDM 278 RC facility both 4636 4636 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 25X15CM 65089847 CDM 278 RC facility both 4636 4636 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 15X15CM 65089848 CDM 278 RC facility both 1889 1889 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 15X15CM 65089848 CDM 278 RC facility both 1889 1889 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETEX VENTRAL PATCH 4.6CM 65089850 CDM 278 RC facility both 1036 1036 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETEX VENTRAL PATCH 4.6CM 65089850 CDM 278 RC facility both 1036 1036 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE 2.3X24MM TORX 65089857 CDM 278 RC facility both 423 423 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BONE 2.3X24MM TORX 65089857 CDM 278 RC facility both 423 423 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ4 16MM 65089867 CDM 278 RC facility both 27983 27983 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ4 16MM 65089867 CDM 278 RC facility both 27983 27983 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 11 STANDARD 6508990 CDM 278 RC facility both 14512 14512 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 11 STANDARD 6508990 CDM 278 RC facility both 14512 14512 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR DISSECTOR 4.0 MM AR-8400DS 65090001 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR DISSECTOR 4.0 MM AR-8400DS 65090001 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0MM FAST HANDINOVATION FDB20 6509003 CDM 272 RC facility both 631 631 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0MM FAST HANDINOVATION FDB20 6509003 CDM 272 RC facility both 631 631 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5MM HANDINOVATION DB25 6509005 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5MM HANDINOVATION DB25 6509005 CDM 272 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.3MM HANDINOVATION DB33 6509007 CDM 272 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.3MM HANDINOVATION DB33 6509007 CDM 272 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE KNEE 101 (STRYKE POWER) 6509016 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE KNEE 101 (STRYKE POWER) 6509016 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO 90 DEG STRAIGHT 65090201 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO 90 DEG STRAIGHT 65090201 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price OSTEOTOME BLADE SHORT CURV 12MM 6509045 CDM 272 RC facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price OSTEOTOME BLADE SHORT CURV 12MM 6509045 CDM 272 RC facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price OSTEOTOME BLADE SHORT 20MM 6509047 CDM 272 RC facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price OSTEOTOME BLADE SHORT 20MM 6509047 CDM 272 RC facility both 391 391 Gross Charge Type: NIHD_Hosp_Profee_Price BONE PREP KIT FEMORAL ZIMMER 6509053 CDM 272 RC facility both 358 358 Gross Charge Type: NIHD_Hosp_Profee_Price BONE PREP KIT FEMORAL ZIMMER 6509053 CDM 272 RC facility both 358 358 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 51MM W/PILOT HOLE 6509054 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 51MM W/PILOT HOLE 6509054 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 46MM W/PILOT HOLE 6509055 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 46MM W/PILOT HOLE 6509055 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE RECIP (ZIMMER) 10376089URI 6509063 CDM 272 RC facility both 490 490 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE RECIP (ZIMMER) 10376089URI 6509063 CDM 272 RC facility both 490 490 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE 19105127AG1 (ZIMMER POWER) 6509064 CDM 272 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE 19105127AG1 (ZIMMER POWER) 6509064 CDM 272 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2X145MM QC 6509072 CDM 272 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2X145MM QC 6509072 CDM 272 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.5X145MM QC 6509073 CDM 272 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.5X145MM QC 6509073 CDM 272 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULA TWIST-IN 6MMX 7CM 6509082 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULA TWIST-IN 6MMX 7CM 6509082 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE CRESCENTIC 12.0X9MM 6509084 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE CRESCENTIC 12.0X9MM 6509084 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULA LOW PROFILE 8.25MMX9CM 6509090 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price CANNULA LOW PROFILE 8.25MMX9CM 6509090 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR BURR OVAL 12 FLUTE 5.5MM 6509131 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR BURR OVAL 12 FLUTE 5.5MM 6509131 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR BURR ROUND 8 FLUTE 4.0MM AR-8400RBE 6509132 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR BURR ROUND 8 FLUTE 4.0MM AR-8400RBE 6509132 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX VOLAR RT STD EX SHORT 65092291 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE VARIAX VOLAR RT STD EX SHORT 65092291 CDM 278 RC facility both 3648 3648 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT W DEPTH MARK 2.5X180MM QC 6509288 CDM 272 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT W DEPTH MARK 2.5X180MM QC 6509288 CDM 272 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHROSCOPY TUBING ONE PIECE AR-6410 6509302 CDM 272 RC facility both 184 184 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHROSCOPY TUBING ONE PIECE AR-6410 6509302 CDM 272 RC facility both 184 184 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR SWIVE LOCK WITHOUT TAPE 6509304 CDM 272 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR SWIVE LOCK WITHOUT TAPE 6509304 CDM 272 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR C 5.5X19.1 AR-2323BCC 6509305 CDM 272 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR C 5.5X19.1 AR-2323BCC 6509305 CDM 272 RC facility both 1199 1199 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR CORKSCREW AR1927BCF 6509306 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR CORKSCREW AR1927BCF 6509306 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR CORKSCREW AR-1927BCF-3 6509307 CDM 272 RC facility both 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR CORKSCREW AR-1927BCF-3 6509307 CDM 272 RC facility both 1020 1020 Gross Charge Type: NIHD_Hosp_Profee_Price TAPE TIGER 2MM 6509308 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price TAPE TIGER 2MM 6509308 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price TAPE FIBER 2MM 6509309 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price TAPE FIBER 2MM 6509309 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR 5.0 DISSECTOR STRAIGHT 6509310 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR 5.0 DISSECTOR STRAIGHT 6509310 CDM 272 RC facility both 178 178 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE SYNDESMOSIS REPAIR TITANIUM 65093214 CDM 278 RC facility both 3524 3524 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE SYNDESMOSIS REPAIR TITANIUM 65093214 CDM 278 RC facility both 3524 3524 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO 45 DEG CURVE RIGHT 6509324 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO 45 DEG CURVE RIGHT 6509324 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO 45 DEG CURVE LEFT 6509325 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO 45 DEG CURVE LEFT 6509325 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE DRILL PIN OPEN EYELET AR-1595T 6509327 CDM 272 RC facility both 376 376 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE DRILL PIN OPEN EYELET AR-1595T 6509327 CDM 272 RC facility both 376 376 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ACL AR-1588T 6509329 CDM 272 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE ACL AR-1588T 6509329 CDM 272 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price ALLEN UNIVERSAL HEAD RESTRAINTDISPOSABLE 6509334 CDM 271 RC facility both 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price ALLEN UNIVERSAL HEAD RESTRAINTDISPOSABLE 6509334 CDM 271 RC facility both 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE DRILL DISP CLOSED EYELET 6509343 CDM 272 RC facility both 376 376 Gross Charge Type: NIHD_Hosp_Profee_Price TIGHTROPE DRILL DISP CLOSED EYELET 6509343 CDM 272 RC facility both 376 376 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERWIRE #2 AR-7233 6509465 CDM 272 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERWIRE #2 AR-7233 6509465 CDM 272 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PERMACOL 5X10X1.00 6509512 CDM 278 RC facility both 3508 3508 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PERMACOL 5X10X1.00 6509512 CDM 278 RC facility both 3508 3508 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR CORKSCREW 3.5 X 10MM 6509666 CDM 272 RC facility both 856 856 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR CORKSCREW 3.5 X 10MM 6509666 CDM 272 RC facility both 856 856 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 4 NEXGEN 6509725 CDM 278 RC facility both 10704 10704 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL COMPONENT SIZE 4 NEXGEN 6509725 CDM 278 RC facility both 10704 10704 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 29MM DIAMETER 6509727 CDM 278 RC facility both 4786 4786 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 29MM DIAMETER 6509727 CDM 278 RC facility both 4786 4786 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR YELLOW/C-H 10MM 6509728 CDM 278 RC facility both 7556 7556 Gross Charge Type: NIHD_Hosp_Profee_Price ARTICULAR SURFACE CR YELLOW/C-H 10MM 6509728 CDM 278 RC facility both 7556 7556 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 41MM W/PILOT HOLE 6509729 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA REAMER BLADE 41MM W/PILOT HOLE 6509729 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX E- LEFT 6509730 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMPONENT CR-FLEX E- LEFT 6509730 CDM 278 RC facility both 20200 20200 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 32MM DIAMETER 00597206632 6509731 CDM 278 RC facility both 5158 5158 Gross Charge Type: NIHD_Hosp_Profee_Price POLY PATELLA STANDARD SIZE 32MM DIAMETER 00597206632 6509731 CDM 278 RC facility both 5158 5158 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR 4.75X19.1MM WITH TIGER TA 65098745 CDM 272 RC facility both 1410 1410 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE ANCHOR 4.75X19.1MM WITH TIGER TA 65098745 CDM 272 RC facility both 1410 1410 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 16 FMMC STD/STD 6509997 CDM 278 RC facility both 21797 21797 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM VERSYS SIZE 16 FMMC STD/STD 6509997 CDM 278 RC facility both 21797 21797 Gross Charge Type: NIHD_Hosp_Profee_Price PULSAVAC WOUND DEBRIDEMENT W/FAN SPRAY 6509999 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price PULSAVAC WOUND DEBRIDEMENT W/FAN SPRAY 6509999 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 16MM 6510099 CDM 278 RC facility both 758 758 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 16MM 6510099 CDM 278 RC facility both 758 758 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 18MM 6510100 CDM 278 RC facility both 727 727 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 18MM 6510100 CDM 278 RC facility both 727 727 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE 2.8X350MM 65101000 CDM 272 RC facility both 259 259 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE 2.8X350MM 65101000 CDM 272 RC facility both 259 259 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 20MM 6510101 CDM 278 RC facility both 758 758 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 20MM 6510101 CDM 278 RC facility both 758 758 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 22MM 6510102 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 22MM 6510102 CDM 278 RC facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 24MM 6510103 CDM 278 RC facility both 758 758 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 24MM 6510103 CDM 278 RC facility both 758 758 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 26MM 6510104 CDM 278 RC facility both 608 608 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 26MM 6510104 CDM 278 RC facility both 608 608 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 28MM 6510105 CDM 278 RC facility both 664 664 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 28MM 6510105 CDM 278 RC facility both 664 664 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 30MM 6510106 CDM 278 RC facility both 608 608 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW HERBERT 30MM 6510106 CDM 278 RC facility both 608 608 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT CANN 5.0X300MM QC 6.5/7.3 6510108 CDM 272 RC facility both 1991 1991 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT CANN 5.0X300MM QC 6.5/7.3 6510108 CDM 272 RC facility both 1991 1991 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X10MM 6510132 CDM 278 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X10MM 6510132 CDM 278 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X12MM 6510133 CDM 278 RC facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X12MM 6510133 CDM 278 RC facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X14MM 6510134 CDM 278 RC facility both 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X14MM 6510134 CDM 278 RC facility both 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X16MM 6510135 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X16MM 6510135 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X18MM 6510136 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X18MM 6510136 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X20MM 6510137 CDM 278 RC facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X20MM 6510137 CDM 278 RC facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X22MM 6510138 CDM 278 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X22MM 6510138 CDM 278 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X24MM 6510139 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X24MM 6510139 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X26MM 6510140 CDM 278 RC facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X26MM 6510140 CDM 278 RC facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X28MM 6510141 CDM 278 RC facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X28MM 6510141 CDM 278 RC facility both 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X10MM 6510142 CDM 278 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X10MM 6510142 CDM 278 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X12MM 6510143 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X12MM 6510143 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X16MM 6510145 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X16MM 6510145 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X18MM 6510146 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X18MM 6510146 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X22MM 6510148 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X22MM 6510148 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X24MM 6510149 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X24MM 6510149 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X26MM 6510150 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X26MM 6510150 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X28MM 6510151 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X28MM 6510151 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X30MM 6510152 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X30MM 6510152 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X32MM 6510153 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X32MM 6510153 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X34MM 6510154 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X34MM 6510154 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X36MM 6510155 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X36MM 6510155 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X40MM 6510157 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X40MM 6510157 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X12MM PART THD 6510159 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X12MM PART THD 6510159 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X14MM PART THD 6510160 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X14MM PART THD 6510160 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X16MM PART THD 6510161 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X16MM PART THD 6510161 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X18MM PART THD 6510162 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X18MM PART THD 6510162 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X20MM PART THD 6510163 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X20MM PART THD 6510163 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X22MM PART THD 6510164 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X22MM PART THD 6510164 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X24MM PART THD 6510165 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X24MM PART THD 6510165 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X26MM PART THD 6510166 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X26MM PART THD 6510166 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X28MM PART THD 6510167 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X28MM PART THD 6510167 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X30MM PART THD 6510168 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X30MM PART THD 6510168 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X35MM PART THD 6510169 CDM 278 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X35MM PART THD 6510169 CDM 278 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X40MM PART THD 6510170 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X40MM PART THD 6510170 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X45MM PART THD 6510171 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X45MM PART THD 6510171 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X50MM PART THD 6510172 CDM 278 RC facility both 222 222 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X50MM PART THD 6510172 CDM 278 RC facility both 222 222 Gross Charge Type: NIHD_Hosp_Profee_Price WASHER 7MM SMALL SCREWS 6510179 CDM facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price WASHER 7MM SMALL SCREWS 6510179 CDM facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X46MM 6510216 CDM 278 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X46MM 6510216 CDM 278 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X50MM 6510217 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X50MM 6510217 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price AGEE WRIST JACK 6510246 CDM 278 RC facility both 4498 4498 Gross Charge Type: NIHD_Hosp_Profee_Price AGEE WRIST JACK 6510246 CDM 278 RC facility both 4498 4498 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TFN TI 5X48MM 6510248 CDM 278 RC facility both 798 798 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TFN TI 5X48MM 6510248 CDM 278 RC facility both 798 798 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TFN TI 5X50MM 6510255 CDM 278 RC facility both 798 798 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK TFN TI 5X50MM 6510255 CDM 278 RC facility both 798 798 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE KIRSCHNER TROCAR 0.6 X 70 MM 6510308 CDM 278 RC facility both 35 35 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE KIRSCHNER TROCAR 0.6 X 70 MM 6510308 CDM 278 RC facility both 35 35 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE BABY 0.035X4IN 6510309 CDM 278 RC facility both 443 443 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE BABY 0.035X4IN 6510309 CDM 278 RC facility both 443 443 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE BABY .045X4IN 6510310 CDM 278 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE BABY .045X4IN 6510310 CDM 278 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE BABY .054X4IN 6510311 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE BABY .054X4IN 6510311 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE BABY .062X4IN 6510312 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE BABY .062X4IN 6510312 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE STEINMAN PIN PLAIN .035X9 6510313 CDM 278 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE STEINMAN PIN PLAIN .035X9 6510313 CDM 278 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE STEINMAN PIN PLAIN .045X9 6510314 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE STEINMAN PIN PLAIN .045X9 6510314 CDM 278 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE STEINMAN PLAIN .062X9 6510315 CDM 278 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE STEINMAN PLAIN .062X9 6510315 CDM 278 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 3/32 (2.3) 6510316 CDM 278 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 3/32 (2.3) 6510316 CDM 278 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 5/32 (3.9) 6510317 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 5/32 (3.9) 6510317 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 5/64 (1.9) 6510318 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 5/64 (1.9) 6510318 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 7/64 (2.7) 6510319 CDM 278 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 7/64 (2.7) 6510319 CDM 278 RC facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 9/64 (3.5) 6510320 CDM 278 RC facility both 144 144 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 9/64 (3.5) 6510320 CDM 278 RC facility both 144 144 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE STEINMAN PIN THREADED .062X9 6510324 CDM 278 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE STEINMAN PIN THREADED .062X9 6510324 CDM 278 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE STATAC 5.0 6510369 CDM 272 RC facility both 894 894 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE STATAC 5.0 6510369 CDM 272 RC facility both 894 894 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE OSCILLATING KM-410S 6510401 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE OSCILLATING KM-410S 6510401 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE OSCILLATING KM-413S 6510402 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE OSCILLATING KM-413S 6510402 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE OSCIL KM-414S 6510403 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE OSCIL KM-414S 6510403 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE OSCIL KM-103S 6510404 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE OSCIL KM-103S 6510404 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X16MM FULL THD 6510460 CDM 278 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X16MM FULL THD 6510460 CDM 278 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X18MM FULL THD 6510461 CDM 278 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X18MM FULL THD 6510461 CDM 278 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X20MM FULL THD 6510462 CDM 278 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X20MM FULL THD 6510462 CDM 278 RC facility both 64 64 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X22MM FULL THD 6510463 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X22MM FULL THD 6510463 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X24MM FULL THD 6510464 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X24MM FULL THD 6510464 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X26MM FULL THD 6510465 CDM 278 RC facility both 60 60 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X26MM FULL THD 6510465 CDM 278 RC facility both 60 60 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X28MM FULL THD 6510466 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X28MM FULL THD 6510466 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X32MM FULL THD 6510467 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X32MM FULL THD 6510467 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price TROCHANTER WIRE COBALT-NICKEL 6510540 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price TROCHANTER WIRE COBALT-NICKEL 6510540 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price TROCHANTERIC WIRE-STAINLESS 6510541 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price TROCHANTERIC WIRE-STAINLESS 6510541 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERWIRE #5 6510555 CDM 272 RC facility both 120 120 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERWIRE #5 6510555 CDM 272 RC facility both 120 120 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 3/16 (4.7) 6510589 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price STEINMAN PIN PLAIN 3/16 (4.7) 6510589 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL ELASTIC TI 2.5MM X 440 PINK 6510631 CDM 278 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL ELASTIC TI 2.5MM X 440 PINK 6510631 CDM 278 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL ELASTIC TI 3.0MM X 440 GOLD 6510632 CDM 278 RC facility both 1727 1727 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL ELASTIC TI 3.0MM X 440 GOLD 6510632 CDM 278 RC facility both 1727 1727 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL ELASTIC TI 3.5MM X 440 BLUE 6510633 CDM 278 RC facility both 1355 1355 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL ELASTIC TI 3.5MM X 440 BLUE 6510633 CDM 278 RC facility both 1355 1355 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DIST RAD L +90 2X3HL 6510669 CDM facility both 1122 1122 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DIST RAD L +90 2X3HL 6510669 CDM facility both 1122 1122 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.4X14MM 6510693 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.4X14MM 6510693 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.4X24MM 6510698 CDM 278 RC facility both 353 353 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.4X24MM 6510698 CDM 278 RC facility both 353 353 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.4X26MM 6510699 CDM 278 RC facility both 353 353 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.4X26MM 6510699 CDM 278 RC facility both 353 353 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.4X28MM 6510703 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 2.4X28MM 6510703 CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price ROPE AG 6510840 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price ROPE AG 6510840 CDM 272 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price AQUACELL EXTRA. 4X5 6510841 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price AQUACELL EXTRA. 4X5 6510841 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG AQUACELL A.G. 8X12 6510842 CDM 272 RC facility both 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG AQUACELL A.G. 8X12 6510842 CDM 272 RC facility both 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEPIN 2.8X300MM THREADED 6510901 CDM 272 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEPIN 2.8X300MM THREADED 6510901 CDM 272 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X30MM 6510903 CDM 278 RC facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X30MM 6510903 CDM 278 RC facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X48MM 6510904 CDM 278 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X48MM 6510904 CDM 278 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X34MM 6510905 CDM 278 RC facility both 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X34MM 6510905 CDM 278 RC facility both 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X36MM 6510906 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X36MM 6510906 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X38MM 6510907 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X38MM 6510907 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X40MM 6510908 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X40MM 6510908 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X42MM 6510909 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X42MM 6510909 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X44MM 6510910 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X44MM 6510910 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X46MM 6510911 CDM 278 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X46MM 6510911 CDM 278 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X52MM 6510918 CDM 278 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X52MM 6510918 CDM 278 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X54MM 6510919 CDM 278 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X54MM 6510919 CDM 278 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X32MM 6510936 CDM 278 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X32MM 6510936 CDM 278 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X28MM 6510999 CDM 278 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X28MM 6510999 CDM 278 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAG KM-106 6511001 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAG KM-106 6511001 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAGITTAL MICRO KM-3237 6511002 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAGITTAL MICRO KM-3237 6511002 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAGITTAL MICRO KM-3102 6511004 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAGITTAL MICRO KM-3102 6511004 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAGITTAL MICRO KM-3240 6511005 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAGITTAL MICRO KM-3240 6511005 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE GIGLI 6511025 CDM 272 RC facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE GIGLI 6511025 CDM 272 RC facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX TWIST DRILL 2.3MM 6511098 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX TWIST DRILL 2.3MM 6511098 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2X195MM QC 6511111 CDM 272 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 3.2X195MM QC 6511111 CDM 272 RC facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.5 X195MM QC 6511112 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4.5 X195MM QC 6511112 CDM 272 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0X100MM QC 6511124 CDM 272 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0X100MM QC 6511124 CDM 272 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5X110MM GOLD QC 6511125 CDM 272 RC facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5X110MM GOLD QC 6511125 CDM 272 RC facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT W DEPTH MARK 1.8X110MM QC 6511165 CDM 272 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT W DEPTH MARK 1.8X110MM QC 6511165 CDM 272 RC facility both 726 726 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE RECIPROCA 277-96-276 (STRYKER) 6511205 CDM 272 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE RECIPROCA 277-96-276 (STRYKER) 6511205 CDM 272 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price REAMING ROD BALL TIP 2.5X950MM 6511227 CDM 272 RC facility both 561 561 Gross Charge Type: NIHD_Hosp_Profee_Price REAMING ROD BALL TIP 2.5X950MM 6511227 CDM 272 RC facility both 561 561 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 12.5MM 6511230 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 12.5MM 6511230 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 13.0MM 6511231 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 13.0MM 6511231 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 13.5MM 6511232 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 13.5MM 6511232 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 14.0MM 6511233 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 14.0MM 6511233 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 15.0MM 6511235 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 15.0MM 6511235 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 15.5MM 6511248 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 15.5MM 6511248 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 16.0MM 6511249 CDM facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 16.0MM 6511249 CDM facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 12.0MM 6511251 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price REAMER HEAD 12.0MM 6511251 CDM 272 RC facility both 1755 1755 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT RADIOLUCENT 3.2MM 6511291 CDM 272 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT RADIOLUCENT 3.2MM 6511291 CDM 272 RC facility both 312 312 Gross Charge Type: NIHD_Hosp_Profee_Price BURR CARBIDE ROUND 2.3MM 6511322 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price BURR CARBIDE ROUND 2.3MM 6511322 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price BURR CYLINDER 1.6MM 6511327 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price BURR CYLINDER 1.6MM 6511327 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-108 6511370 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-108 6511370 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-111 6511371 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-111 6511371 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-125 6511373 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-125 6511373 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-225 6511375 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-225 6511375 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price IDENTIFICATION BAND ILIZIROV 6511382 CDM 272 RC facility both 1009 1009 Gross Charge Type: NIHD_Hosp_Profee_Price IDENTIFICATION BAND ILIZIROV 6511382 CDM 272 RC facility both 1009 1009 Gross Charge Type: NIHD_Hosp_Profee_Price BALL PIN JURGAN 5/64 BL 6511388 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BALL PIN JURGAN 5/64 BL 6511388 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BURR ROUND 3.0 SHORT 6511432 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BURR ROUND 3.0 SHORT 6511432 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.8X165MM QC 6511448 CDM 272 RC facility both 331 331 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.8X165MM QC 6511448 CDM 272 RC facility both 331 331 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0X125MM QC 6511461 CDM 272 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0X125MM QC 6511461 CDM 272 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERWIRE #2 SUTURE BLUE BLACK WHITE 6511543 CDM 272 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERWIRE #2 SUTURE BLUE BLACK WHITE 6511543 CDM 272 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.7X125MM QC 6511578 CDM 272 RC facility both 645 645 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.7X125MM QC 6511578 CDM 272 RC facility both 645 645 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT ARTHR GII 2.4 651159 CDM 272 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT ARTHR GII 2.4 651159 CDM 272 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price BURR ROUND 6.0 SHORT 6511608 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price BURR ROUND 6.0 SHORT 6511608 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price POWERPICK 45DEG 6MM DRILL DEPTH 65116524 CDM 278 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price POWERPICK 45DEG 6MM DRILL DEPTH 65116524 CDM 278 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAG 6118-127-100 STRYKER 65116587 CDM 272 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAG 6118-127-100 STRYKER 65116587 CDM 272 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAG 6125-127-090 STRYKER 65116588 CDM 272 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAG 6125-127-090 STRYKER 65116588 CDM 272 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERLOOP 2-0 6511666 CDM 272 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERLOOP 2-0 6511666 CDM 272 RC facility both 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price NITINOL WIRE SUTURE PASSER AR-1255-18 6511667 CDM 272 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price NITINOL WIRE SUTURE PASSER AR-1255-18 6511667 CDM 272 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE ACUMED .054 X 6MM WS-1406ST 6511678 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE ACUMED .054 X 6MM WS-1406ST 6511678 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT ACUTRAK 2 PROFILE 6511684 CDM 272 RC facility both 1012 1012 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT ACUTRAK 2 PROFILE 6511684 CDM 272 RC facility both 1012 1012 Gross Charge Type: NIHD_Hosp_Profee_Price KNOT PUSHER/S SUTURE CUTTER FAST-FIX 6511685 CDM 278 RC facility both 582 582 Gross Charge Type: NIHD_Hosp_Profee_Price KNOT PUSHER/S SUTURE CUTTER FAST-FIX 6511685 CDM 278 RC facility both 582 582 Gross Charge Type: NIHD_Hosp_Profee_Price POWER PIK 45 DEGREE ARTHREX 6511686 CDM facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price POWER PIK 45 DEGREE ARTHREX 6511686 CDM facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT ACUTRAK 2 LONG 6511687 CDM 272 RC facility both 1012 1012 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT ACUTRAK 2 LONG 6511687 CDM 272 RC facility both 1012 1012 Gross Charge Type: NIHD_Hosp_Profee_Price APOLLO RF HOOK PROBE 6511698 CDM 272 RC facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price APOLLO RF HOOK PROBE 6511698 CDM 272 RC facility both 556 556 Gross Charge Type: NIHD_Hosp_Profee_Price PROXIMAL TENODESIS IMPLANT SYSTEM 6511699 CDM 278 RC facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price PROXIMAL TENODESIS IMPLANT SYSTEM 6511699 CDM 278 RC facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE ALIGN 2 6511700 CDM 278 RC facility both 3884 3884 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE ALIGN 2 6511700 CDM 278 RC facility both 3884 3884 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 8MM 6511786 CDM facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 8MM 6511786 CDM facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 10MM 6511788 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 10MM 6511788 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 9.5MM 6511789 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 9.5MM 6511789 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 8.5MM 6511799 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 8.5MM 6511799 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX TAP 2.7X50MM 6511874 CDM 278 RC facility both 437 437 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX TAP 2.7X50MM 6511874 CDM 278 RC facility both 437 437 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW MINI ACUTRAK 2 22.0MM 6511894 CDM facility both 1732 1732 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW MINI ACUTRAK 2 22.0MM 6511894 CDM facility both 1732 1732 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE 25090127AD1 (ZIMMER POWER) 6511898 CDM 272 RC facility both 532 532 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE 25090127AD1 (ZIMMER POWER) 6511898 CDM 272 RC facility both 532 532 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX TWIST DRILL 2.3MM STRYKER 6511899 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price VARIAX TWIST DRILL 2.3MM STRYKER 6511899 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price TRANSTIBIAL ACL DISP KIT 6511918 CDM 272 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price TRANSTIBIAL ACL DISP KIT 6511918 CDM 272 RC facility both 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERLOOP #2 LOOPED AR-7234 6511919 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERLOOP #2 LOOPED AR-7234 6511919 CDM 272 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 9MM 6511924 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER 9MM 6511924 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price MIXING & DELIVERY SYSTEM 3CC - ARTHREX 6511925 CDM 272 RC facility both 568 568 Gross Charge Type: NIHD_Hosp_Profee_Price MIXING & DELIVERY SYSTEM 3CC - ARTHREX 6511925 CDM 272 RC facility both 568 568 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR 4.0 TORPEDO AR-8400TD 6511926 CDM 272 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR 4.0 TORPEDO AR-8400TD 6511926 CDM 272 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER - 6MM 6511954 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price FLIP CUTTER - 6MM 6511954 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT HIP 30MM - DEPUY 6511978 CDM 272 RC facility both 1316 1316 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT HIP 30MM - DEPUY 6511978 CDM 272 RC facility both 1316 1316 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL VARIAX 2.0 AO 6511985 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL VARIAX 2.0 AO 6511985 CDM 272 RC facility both 428 428 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT ACUTRAK 2 MICRO LONG 6511987 CDM 272 RC facility both 1500 1500 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT ACUTRAK 2 MICRO LONG 6511987 CDM 272 RC facility both 1500 1500 Gross Charge Type: NIHD_Hosp_Profee_Price DAVINCI FIREFLY DYE IGE 65119874 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price DAVINCI FIREFLY DYE IGE 65119874 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE 130-60127AF1 (ZIMMER ) 6511994 CDM 272 RC facility both 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE 130-60127AF1 (ZIMMER ) 6511994 CDM 272 RC facility both 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR POWERASP 4.0MM AR-8400PR 6511995 CDM 272 RC facility both 436 436 Gross Charge Type: NIHD_Hosp_Profee_Price SHVR POWERASP 4.0MM AR-8400PR 6511995 CDM 272 RC facility both 436 436 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE ACUMED 0.035X5.75 6511998 CDM 272 RC facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDE WIRE ACUMED 0.035X5.75 6511998 CDM 272 RC facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE 25090127AB1 (ZIMMER POWER) 6511999 CDM 272 RC facility both 532 532 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE 25090127AB1 (ZIMMER POWER) 6511999 CDM 272 RC facility both 532 532 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT BIF HEMASHIELD 20X10 6512014 CDM 278 RC facility both 2888 2888 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT BIF HEMASHIELD 20X10 6512014 CDM 278 RC facility both 2888 2888 Gross Charge Type: NIHD_Hosp_Profee_Price POWERPORT GROSHONG 8.0FR SUT PLUG 180856 6512065 CDM 272 RC facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price POWERPORT GROSHONG 8.0FR SUT PLUG 180856 6512065 CDM 272 RC facility both 819 819 Gross Charge Type: NIHD_Hosp_Profee_Price SEPRA FILM 5X6 SHEET 6512212 CDM 272 RC facility both 896 896 Gross Charge Type: NIHD_Hosp_Profee_Price SEPRA FILM 5X6 SHEET 6512212 CDM 272 RC facility both 896 896 Gross Charge Type: NIHD_Hosp_Profee_Price VALVULATOME EXP 1.8-6.0 6512356 CDM 272 RC facility both 4045 4045 Gross Charge Type: NIHD_Hosp_Profee_Price VALVULATOME EXP 1.8-6.0 6512356 CDM 272 RC facility both 4045 4045 Gross Charge Type: NIHD_Hosp_Profee_Price CATH EMBOLECTOMY 2FR 6512368 CDM 272 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price CATH EMBOLECTOMY 2FR 6512368 CDM 272 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price CATH EMBOLECTOMY 3FR 6512369 CDM 272 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price CATH EMBOLECTOMY 3FR 6512369 CDM 272 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price CATH EMBOLECTOMY 4FR 6512370 CDM 272 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price CATH EMBOLECTOMY 4FR 6512370 CDM 272 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price CATH EMBOLECTOMY 5FR 6512371 CDM 272 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price CATH EMBOLECTOMY 5FR 6512371 CDM 272 RC facility both 145 145 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT BIF HEMASHIELD 24X12 6512430 CDM 278 RC facility both 2888 2888 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT BIF HEMASHIELD 24X12 6512430 CDM 278 RC facility both 2888 2888 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 52MM SIZE II MULTI HL 65130007 CDM 278 RC facility both 15232 15232 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 52MM SIZE II MULTI HL 65130007 CDM 278 RC facility both 15232 15232 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT SZ36MM II VIVACIT 65130008 CDM 278 RC facility both 10284 10284 Gross Charge Type: NIHD_Hosp_Profee_Price ACETAB LINER NEUT SZ36MM II VIVACIT 65130008 CDM 278 RC facility both 10284 10284 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X330MM 65130012 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 8X330MM 65130012 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X375MM 65130014 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X375MM 65130014 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT PERONEUS LONGUS TENDON 65130015 CDM 278 RC facility both 2519 2519 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT PERONEUS LONGUS TENDON 65130015 CDM 278 RC facility both 2519 2519 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC 36MM +0C-TPR 65130022 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC 36MM +0C-TPR 65130022 CDM 278 RC facility both 7496 7496 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CORTICAL STRUTT 180MM FROZEN 65130023 CDM 278 RC facility both 1072 1072 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT CORTICAL STRUTT 180MM FROZEN 65130023 CDM 278 RC facility both 1072 1072 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT BONE FEMORAL SHAFT FROZEN 65130024 CDM facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT BONE FEMORAL SHAFT FROZEN 65130024 CDM facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERAL FRACTURE STEM 10MM 65130030 CDM 278 RC facility both 18845 18845 Gross Charge Type: NIHD_Hosp_Profee_Price HUMERAL FRACTURE STEM 10MM 65130030 CDM 278 RC facility both 18845 18845 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM SIZE 11 FMMC STAND LM BODY 65130099 CDM 278 RC facility both 22683 22683 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM SIZE 11 FMMC STAND LM BODY 65130099 CDM 278 RC facility both 22683 22683 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X360MM 6513013 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price NAIL TIBIAL EX TI CANNULATED 9X360MM 6513013 CDM 278 RC facility both 5997 5997 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X35MM FULL THD 6513161 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X35MM FULL THD 6513161 CDM 278 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X40MM FULL THD 6513162 CDM 278 RC facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X40MM FULL THD 6513162 CDM 278 RC facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X45MM FULL THD 6513163 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X45MM FULL THD 6513163 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X50MM FULL THD 6513164 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X50MM FULL THD 6513164 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X55MM FULL THD 6513165 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X55MM FULL THD 6513165 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X60MM FULL THD 6513166 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X60MM FULL THD 6513166 CDM 278 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT ACHILLES TENDON FF 6513188 CDM 278 RC facility both 3418 3418 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT ACHILLES TENDON FF 6513188 CDM 278 RC facility both 3418 3418 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X30MM 6513258 CDM 278 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X30MM 6513258 CDM 278 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X36MM 6513259 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X36MM 6513259 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X38MM 6513260 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X38MM 6513260 CDM 278 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X40MM 6513278 CDM 278 RC facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X40MM 6513278 CDM 278 RC facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X32MM 6513279 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X32MM 6513279 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X34MM 6513280 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X34MM 6513280 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT PRO SOTEON 500R GRANNULES (5RG05) 6513288 CDM 278 RC facility both 1323 1323 Gross Charge Type: NIHD_Hosp_Profee_Price GRAFT PRO SOTEON 500R GRANNULES (5RG05) 6513288 CDM 278 RC facility both 1323 1323 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X50MM 6513334 CDM 278 RC facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 4.5X50MM 6513334 CDM 278 RC facility both 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 1.25MM TROCAR SINGLE PT 6513388 CDM 278 RC facility both 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 1.25MM TROCAR SINGLE PT 6513388 CDM 278 RC facility both 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE EXFIX 1.6MM THD/TROCAR DBLE PT 6513389 CDM 278 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE EXFIX 1.6MM THD/TROCAR DBLE PT 6513389 CDM 278 RC facility both 810 810 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 2.0MM TROCAR SINGLE PT 6513390 CDM 278 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 2.0MM TROCAR SINGLE PT 6513390 CDM 278 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 5HL 6513391 CDM facility both 634 634 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 5HL 6513391 CDM facility both 634 634 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 6HL 6513392 CDM 278 RC facility both 1821 1821 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 6HL 6513392 CDM 278 RC facility both 1821 1821 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 8HL 6513393 CDM facility both 1318 1318 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 8HL 6513393 CDM facility both 1318 1318 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 9HL 6513394 CDM 278 RC facility both 1463 1463 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 9HL 6513394 CDM 278 RC facility both 1463 1463 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 10HL 6513395 CDM facility both 1067 1067 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 10HL 6513395 CDM facility both 1067 1067 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 12HL 6513396 CDM facility both 948 948 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 12HL 6513396 CDM facility both 948 948 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 14HL 6513397 CDM 278 RC facility both 1314 1314 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 14HL 6513397 CDM 278 RC facility both 1314 1314 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 5HLX70MM 6513398 CDM facility both 2348 2348 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 5HLX70MM 6513398 CDM facility both 2348 2348 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 6HLX84MM 6513399 CDM facility both 1655 1655 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 6HLX84MM 6513399 CDM facility both 1655 1655 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 7HLX98MM 6513400 CDM facility both 3044 3044 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 7HLX98MM 6513400 CDM facility both 3044 3044 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 8HLX112MM 6513401 CDM facility both 1602 1602 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 8HLX112MM 6513401 CDM facility both 1602 1602 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 10HLX140MM 6513402 CDM facility both 3081 3081 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 10HLX140MM 6513402 CDM facility both 3081 3081 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 12HLX168MM 6513403 CDM facility both 2225 2225 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM RECON 12HLX168MM 6513403 CDM facility both 2225 2225 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 3X3HL 50MM RT ANGLE 6513404 CDM 278 RC facility both 1121 1121 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 3X3HL 50MM RT ANGLE 6513404 CDM 278 RC facility both 1121 1121 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 3X5HL 67MM RT ANGLE 6513405 CDM facility both 772 772 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 3X5HL 67MM RT ANGLE 6513405 CDM facility both 772 772 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 4X4HL 56MM RT ANGLE 6513406 CDM facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 4X4HL 56MM RT ANGLE 6513406 CDM facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 3X7HL 87MM RT ANGLE 6513407 CDM facility both 1128 1128 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 3X7HL 87MM RT ANGLE 6513407 CDM facility both 1128 1128 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 4X6HL 78MM RT ANGLE 6513408 CDM facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM T 4X6HL 78MM RT ANGLE 6513408 CDM facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 5HL 6513417 CDM 278 RC facility both 1001 1001 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 5HL 6513417 CDM 278 RC facility both 1001 1001 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 6HL 6513418 CDM 278 RC facility both 801 801 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 6HL 6513418 CDM 278 RC facility both 801 801 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 7HL 6513419 CDM 278 RC facility both 816 816 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 7HL 6513419 CDM 278 RC facility both 816 816 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 8HL 6513420 CDM 278 RC facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 8HL 6513420 CDM 278 RC facility both 862 862 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE3.5MM LCP 1/3 TUBULAR 10HL 6513421 CDM 278 RC facility both 1098 1098 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE3.5MM LCP 1/3 TUBULAR 10HL 6513421 CDM 278 RC facility both 1098 1098 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 12HL 6513422 CDM 278 RC facility both 1125 1125 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE 3.5MM LCP 1/3 TUBULAR 12HL 6513422 CDM 278 RC facility both 1125 1125 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X10MM 6513423 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X10MM 6513423 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X12MM 6513424 CDM 278 RC facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X12MM 6513424 CDM 278 RC facility both 558 558 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X14MM 6513425 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X14MM 6513425 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X16MM 6513426 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X16MM 6513426 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X18MM 6513427 CDM 278 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X18MM 6513427 CDM 278 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X20MM 6513428 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X20MM 6513428 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X22MM 6513429 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X22MM 6513429 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X24MM 6513430 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X24MM 6513430 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X26MM 6513431 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X26MM 6513431 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X28MM 6513432 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X28MM 6513432 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X30MM 6513433 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X30MM 6513433 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X32MM 6513434 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X32MM 6513434 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X34MM 6513435 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X34MM 6513435 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X36MM 6513436 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X36MM 6513436 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X38MM 6513437 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X38MM 6513437 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X40MM 6513438 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X40MM 6513438 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X45MM 6513439 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X45MM 6513439 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X50MM 6513440 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X50MM 6513440 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X55MM 6513441 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X55MM 6513441 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X60MM 6513442 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCK 3.5X60MM 6513442 CDM 278 RC facility both 688 688 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X30MM FULL THD 6513456 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X30MM FULL THD 6513456 CDM 278 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X38MM 6513458 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X38MM 6513458 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X42MM 6513459 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X42MM 6513459 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X44MM 6513460 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X44MM 6513460 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X48MM 6513461 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X48MM 6513461 CDM 278 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X55MM 6513462 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X55MM 6513462 CDM 278 RC facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM PROXIMAL HUMERAL 3HL 6513473 CDM 278 RC facility both 7190 7190 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM PROXIMAL HUMERAL 3HL 6513473 CDM 278 RC facility both 7190 7190 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X45MM 6513474 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X45MM 6513474 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM PROXIMAL HUMERAL 5HL 6513475 CDM 278 RC facility both 7418 7418 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE LCP 3.5MM PROXIMAL HUMERAL 5HL 6513475 CDM 278 RC facility both 7418 7418 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X60MM 6513503 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X60MM 6513503 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X50MM 6513507 CDM 278 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X50MM 6513507 CDM 278 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X10MM PART THD 6513509 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC 4.0X10MM PART THD 6513509 CDM 278 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X45MM 6513511 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 3.5X45MM 6513511 CDM 278 RC facility both 78 78 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X55MM 6513518 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.7X55MM 6513518 CDM 278 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price BONE PUTTY 5CC DBX 6513526 CDM 278 RC facility both 2977 2977 Gross Charge Type: NIHD_Hosp_Profee_Price BONE PUTTY 5CC DBX 6513526 CDM 278 RC facility both 2977 2977 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X80MM 16MM THD 6513578 CDM 278 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X80MM 16MM THD 6513578 CDM 278 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X85MM 16MM THD 6513579 CDM 278 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X85MM 16MM THD 6513579 CDM 278 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X90MM 16MM THD 6513580 CDM 278 RC facility both 1512 1512 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X90MM 16MM THD 6513580 CDM 278 RC facility both 1512 1512 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X95MM 16MM THD 6513581 CDM 278 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X95MM 16MM THD 6513581 CDM 278 RC facility both 1276 1276 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X100MM 16MM THD 6513582 CDM 278 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X100MM 16MM THD 6513582 CDM 278 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X110MM 16MM THD 6513584 CDM 278 RC facility both 1191 1191 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X110MM 16MM THD 6513584 CDM 278 RC facility both 1191 1191 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X65MM 32MM THD 6513592 CDM 278 RC facility both 1113 1113 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X65MM 32MM THD 6513592 CDM 278 RC facility both 1113 1113 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X80MM 32MM THD 6513595 CDM 278 RC facility both 1191 1191 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X80MM 32MM THD 6513595 CDM 278 RC facility both 1191 1191 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X85MM 32MM THD 6513596 CDM 278 RC facility both 1191 1191 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X85MM 32MM THD 6513596 CDM 278 RC facility both 1191 1191 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X90MM 32MM THD 6513597 CDM 278 RC facility both 1512 1512 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X90MM 32MM THD 6513597 CDM 278 RC facility both 1512 1512 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X95MM 32MM THD 6513598 CDM 278 RC facility both 1512 1512 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X95MM 32MM THD 6513598 CDM 278 RC facility both 1512 1512 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X100MM 32MM THD 6513599 CDM facility both 1172 1172 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X100MM 32MM THD 6513599 CDM facility both 1172 1172 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC STANDARD RT 6513690 CDM 278 RC facility both 3988 3988 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC STANDARD RT 6513690 CDM 278 RC facility both 3988 3988 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC STANDARD LT 6513691 CDM 278 RC facility both 3238 3238 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC STANDARD LT 6513691 CDM 278 RC facility both 3238 3238 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC NARROW SHORT RT 6513692 CDM 278 RC facility both 3988 3988 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC NARROW SHORT RT 6513692 CDM 278 RC facility both 3988 3988 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC NARROW SHORT LT 6513693 CDM 278 RC facility both 3988 3988 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC NARROW SHORT LT 6513693 CDM 278 RC facility both 3988 3988 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC WIDE RT 6513694 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC WIDE RT 6513694 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC WIDE LT 6513695 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC WIDE LT 6513695 CDM 278 RC facility both 3689 3689 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC EXT RT 6513696 CDM 278 RC facility both 3809 3809 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC EXT RT 6513696 CDM 278 RC facility both 3809 3809 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC EXT LT 6513697 CDM 278 RC facility both 3809 3809 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DVR ANATOMIC EXT LT 6513697 CDM 278 RC facility both 3809 3809 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DORSAL DNP-RT 6513698 CDM 278 RC facility both 2085 2085 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DORSAL DNP-RT 6513698 CDM 278 RC facility both 2085 2085 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DORSAL DNP-LT 6513699 CDM 278 RC facility both 2085 2085 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DORSAL DNP-LT 6513699 CDM 278 RC facility both 2085 2085 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE FRAG STRAIGHT 6513700 CDM 278 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE FRAG STRAIGHT 6513700 CDM 278 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE FRAG HOCKEY ST LT 6513701 CDM 278 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE FRAG HOCKEY ST LT 6513701 CDM 278 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE FRAG HOCKEY ST RT 6513702 CDM 278 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE FRAG HOCKEY ST RT 6513702 CDM 278 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE FRAG Y 6513703 CDM 278 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE FRAG Y 6513703 CDM 278 RC facility both 1485 1485 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X14MM 6513704 CDM 278 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X14MM 6513704 CDM 278 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X16MM 6513705C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X16MM 6513705C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X18MM 6513706C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X18MM 6513706C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X20MM 6513707C CDM 278 RC facility both 541 541 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X20MM 6513707C CDM 278 RC facility both 541 541 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X22MM 6513708C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X22MM 6513708C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X24MM 6513709C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X24MM 6513709C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X26MM 6513710C CDM 278 RC facility both 387 387 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X26MM 6513710C CDM 278 RC facility both 387 387 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X28MM 6513711C CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price PEG SMOOTH LOCK 2.0X28MM 6513711C CDM 278 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X14MM 6513712C CDM 278 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X14MM 6513712C CDM 278 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X16MM 6513713C CDM 278 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X16MM 6513713C CDM 278 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X18MM 6513714C CDM 278 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X18MM 6513714C CDM 278 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X20MM 6513715C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X20MM 6513715C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X22MM 6513716C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X22MM 6513716C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X24MM 6513717C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X24MM 6513717C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X26MM 6513718C CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X26MM 6513718C CDM 278 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X28MM 6513719C CDM 278 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X28MM 6513719C CDM 278 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X30MM 6513720C CDM 278 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price PEG PART THRD LOCK 2.5X30MM 6513720C CDM 278 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X16MM 6513722C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X16MM 6513722C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X18MM 6513723C CDM 278 RC facility both 541 541 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X18MM 6513723C CDM 278 RC facility both 541 541 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X20MM 6513724C CDM 278 RC facility both 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X20MM 6513724C CDM 278 RC facility both 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X22MM 6513725C CDM 278 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X22MM 6513725C CDM 278 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X24MM 6513726C CDM 278 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X24MM 6513726C CDM 278 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X26MM 6513727C CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X26MM 6513727C CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X28MM 6513728C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X28MM 6513728C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X30MM 6513729C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price PEG FULL THRD LOCK 2.5X30MM 6513729C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X14MM 6513730C CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X14MM 6513730C CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X16MM 6513731C CDM 278 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X16MM 6513731C CDM 278 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X18MM 6513732C CDM 278 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X18MM 6513732C CDM 278 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X20MM 6513733C CDM 278 RC facility both 334 334 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X20MM 6513733C CDM 278 RC facility both 334 334 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X22MM 6513734C CDM 278 RC facility both 284 284 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X22MM 6513734C CDM 278 RC facility both 284 284 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X24MM 6513735C CDM 278 RC facility both 303 303 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X24MM 6513735C CDM 278 RC facility both 303 303 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X26MM 6513736C CDM 278 RC facility both 353 353 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X26MM 6513736C CDM 278 RC facility both 353 353 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X28MM 6513737C CDM 278 RC facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANC TI 2.5X28MM 6513737C CDM 278 RC facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X10MM BIOMET 6513738C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X10MM BIOMET 6513738C CDM 278 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X12MM BIOMET 6513739C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X12MM BIOMET 6513739C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X14MM BIOMET 6513740C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X14MM BIOMET 6513740C CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X16MM BIOMET 6513741C CDM 278 RC facility both 1909 1909 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X16MM BIOMET 6513741C CDM 278 RC facility both 1909 1909 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X18MM BIOMET 6513742C CDM 278 RC facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT TI 3.5X18MM BIOMET 6513742C CDM 278 RC facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.6X127MM SS HANDINOVATION KWO62S 6513744 CDM 278 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.6X127MM SS HANDINOVATION KWO62S 6513744 CDM 278 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X70MM 16MM THD 6513800 CDM 278 RC facility both 852 852 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CANNU 7.3X70MM 16MM THD 6513800 CDM 278 RC facility both 852 852 Gross Charge Type: NIHD_Hosp_Profee_Price BONE PUTTY 1CC DBX 6513999 CDM 278 RC facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price BONE PUTTY 1CC DBX 6513999 CDM 278 RC facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZLB00 17.5 1 PIECE 3.25 65140003 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZLB00 17.5 1 PIECE 3.25 65140003 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 19.0 BUNDLE 6514068 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 19.0 BUNDLE 6514068 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 06.0 BUNDLE 6514074 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 06.0 BUNDLE 6514074 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 05.5 BDL 6514079 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 05.5 BDL 6514079 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 05.0 BDL 6514080 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 05.0 BDL 6514080 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 7.5 BDL 6514091 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 7.5 BDL 6514091 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 19.0 3 PIECE 6514114 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMA00 19.0 3 PIECE 6514114 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 8.0 BDL 6514121 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 8.0 BDL 6514121 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 11.5 BDL 6514124 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 11.5 BDL 6514124 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 12.0 BDL 6514125 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 12.0 BDL 6514125 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 12.5 BDL 6514126 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 12.5 BDL 6514126 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 10.5 BDL 6514127 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 10.5 BDL 6514127 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 13.0 BDL 6514128 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 13.0 BDL 6514128 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 10.0 BDL 6514129 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 10.0 BDL 6514129 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 9.5 BDL 6514138 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 9.5 BDL 6514138 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 9.0 BDL 6514156 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 9.0 BDL 6514156 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price CAPSULAR TENSION RING 12MM 6514164 CDM 278 RC facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price CAPSULAR TENSION RING 12MM 6514164 CDM 278 RC facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 05.0 BUNDLE 6514170 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 05.0 BUNDLE 6514170 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 03.0 BDL 6514211 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 03.0 BDL 6514211 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 7.0 BUNDLE 6514248 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 7.0 BUNDLE 6514248 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price GAS ESCALON SULFUR HEXAFLUORIDE 6514277 CDM 278 RC facility both 2999 2999 Gross Charge Type: NIHD_Hosp_Profee_Price GAS ESCALON SULFUR HEXAFLUORIDE 6514277 CDM 278 RC facility both 2999 2999 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 15.0 BDL 6514606 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 15.0 BDL 6514606 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 15.5 BDL 6514607 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 15.5 BDL 6514607 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 16.0 BDL 6514608 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 16.0 BDL 6514608 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 16.5 BDL 6514609 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 16.5 BDL 6514609 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 17.0 BDL 6514610 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 17.0 BDL 6514610 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 17.5 BDL 6514611 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 17.5 BDL 6514611 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 18.0 BDL 6514612 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 18.0 BDL 6514612 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 18.5 BDL 6514613 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 18.5 BDL 6514613 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 19.0 BDL 6514614 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 19.0 BDL 6514614 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 19.5 BDL 6514615 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 19.5 BDL 6514615 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 20.0 BDL 6514616 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 20.0 BDL 6514616 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 20.5 BDL 6514617 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 20.5 BDL 6514617 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 21.0 BDL 6514618 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 21.0 BDL 6514618 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 21.5 BDL 6514619 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 21.5 BDL 6514619 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 22.0 BDL 6514620 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 22.0 BDL 6514620 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 22.5 BDL 6514621 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 22.5 BDL 6514621 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 23.0 BDL 6514622 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 23.0 BDL 6514622 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 23.5 BDL 6514623 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 23.5 BDL 6514623 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 24.0 BDL 6514624 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 24.0 BDL 6514624 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 24.5 BDL 6514625 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 24.5 BDL 6514625 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 25.0 BDL 6514626 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 25.0 BDL 6514626 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 25.5 BDL 6514627 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 25.5 BDL 6514627 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 26.0 BDL 6514628 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 26.0 BDL 6514628 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 26.5 BDL 6514629 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 26.5 BDL 6514629 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 27.0 BDL 6514630 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 27.0 BDL 6514630 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 27.5 BDL 6514631 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 27.5 BDL 6514631 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 14.0 BDL 6514637 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 14.0 BDL 6514637 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 11.0 BDL 6514640 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 11.0 BDL 6514640 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 14.5 BDL 6514652 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 14.5 BDL 6514652 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 13.5 BDL 6514653 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 13.5 BDL 6514653 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL AC21D3 17.0 6514724 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL AC21D3 17.0 6514724 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 10.0 BUNDLE 6514736 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 10.0 BUNDLE 6514736 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 11.0 BUNDLE 6514738 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 11.0 BUNDLE 6514738 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 11.5 BUNDLE 6514739 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 11.5 BUNDLE 6514739 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 12.0 BUNDLE 6514740 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 12.0 BUNDLE 6514740 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 12.5 BUNDLE 6514741 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 12.5 BUNDLE 6514741 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 13.0 BUNDLE 6514742 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 13.0 BUNDLE 6514742 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 13.5 BUNDLE 6514743 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 13.5 BUNDLE 6514743 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 14.0 BUNDLE 6514744 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 14.0 BUNDLE 6514744 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 14.5 BUNDLE 6514745 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 14.5 BUNDLE 6514745 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 15.0 BUNDLE 6514746 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 15.0 BUNDLE 6514746 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 15.5 BUNDLE 6514747 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 15.5 BUNDLE 6514747 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 16.0 BUNDLE 6514748 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 16.0 BUNDLE 6514748 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 16.5 BUNDLE 6514749 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 16.5 BUNDLE 6514749 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 17.0 BUNDLE 6514750 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 17.0 BUNDLE 6514750 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 17.5 BUNDLE 6514751 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 17.5 BUNDLE 6514751 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 18.0 BUNDLE 6514752 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 18.0 BUNDLE 6514752 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 18.5 BUNDLE 6514753 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 18.5 BUNDLE 6514753 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 19.5 BUNDLE 6514754 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 19.5 BUNDLE 6514754 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 20.0 BUNDLE 6514755 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 20.0 BUNDLE 6514755 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 20.5 BUNDLE 6514756 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 20.5 BUNDLE 6514756 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 21.0 BUNDLE 6514757 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 21.0 BUNDLE 6514757 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 22.0 BUNDLE 6514759 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 22.0 BUNDLE 6514759 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 22.5 BUNDLE 6514760 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 22.5 BUNDLE 6514760 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 23.5 BUNDLE 6514762 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 23.5 BUNDLE 6514762 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 24.0 BUNDLE 6514763 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 24.0 BUNDLE 6514763 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 24.5 BUNDLE 6514764 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 24.5 BUNDLE 6514764 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 25.0 BUNDLE 6514765 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 25.0 BUNDLE 6514765 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 25.5 BUNDLE 6514766 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 25.5 BUNDLE 6514766 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 26.0 BUNDLE 6514767 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 26.0 BUNDLE 6514767 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 26.5 BUNDLE 6514768 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 26.5 BUNDLE 6514768 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 27.0 BUNDLE 6514769 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 27.0 BUNDLE 6514769 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 27.5 BUNDLE 6514770 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 27.5 BUNDLE 6514770 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 28.0 BUNDLE 6514771 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 28.0 BUNDLE 6514771 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 28.5 BUNDLE 6514772 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 28.5 BUNDLE 6514772 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 29.0 BUNDLE 6514773 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 29.0 BUNDLE 6514773 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 29.5 BUNDLE 6514774 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 29.5 BUNDLE 6514774 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 30.0 BUNDLE 6514775 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 30.0 BUNDLE 6514775 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 8.0 BUNDLE 6514812 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 8.0 BUNDLE 6514812 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IRIS EXPANSION SYSTEM - XPAND 6515175 CDM 272 RC facility both 376 376 Gross Charge Type: NIHD_Hosp_Profee_Price IRIS EXPANSION SYSTEM - XPAND 6515175 CDM 272 RC facility both 376 376 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT CANNULATED 2.0MM ARTHREX 6515252 CDM 272 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT CANNULATED 2.0MM ARTHREX 6515252 CDM 272 RC facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price SONICISION 5MM 26 CM L DISSECTOR SCD26 6515265 CDM 272 RC facility both 2089 2089 Gross Charge Type: NIHD_Hosp_Profee_Price SONICISION 5MM 26 CM L DISSECTOR SCD26 6515265 CDM 272 RC facility both 2089 2089 Gross Charge Type: NIHD_Hosp_Profee_Price PORT CLOSURE CARTER-THOMASON II 65152655 CDM 272 RC facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price PORT CLOSURE CARTER-THOMASON II 65152655 CDM 272 RC facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price ADVINCULA DELINEATOR (RUMI) 2.5 CM 65152656 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price ADVINCULA DELINEATOR (RUMI) 2.5 CM 65152656 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price ADVINCULA DELINEATOR (RUMI) 3.0CM 65152657 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price ADVINCULA DELINEATOR (RUMI) 3.0CM 65152657 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price ADVINCULA DELINEATOR (RUMI) 3.5CM 65152658 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price ADVINCULA DELINEATOR (RUMI) 3.5CM 65152658 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price ADVINCULA DELINEATOR (RUMI) 4.0CM 65152659 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price ADVINCULA DELINEATOR (RUMI) 4.0CM 65152659 CDM 272 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price TAPE SUTURE ARTHROSCOPY 65152809 CDM 272 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price TAPE SUTURE ARTHROSCOPY 65152809 CDM 272 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price LAPSAC SIZE 5 X 8 IN 6515282 CDM 272 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price LAPSAC SIZE 5 X 8 IN 6515282 CDM 272 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price LAPSAC SIZE 8 X 10 IN 6515336 CDM 272 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price LAPSAC SIZE 8 X 10 IN 6515336 CDM 272 RC facility both 240 240 Gross Charge Type: NIHD_Hosp_Profee_Price SHAVER TORPEDO CURVED 8400CTD 6515433 CDM 272 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price SHAVER TORPEDO CURVED 8400CTD 6515433 CDM 272 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price IRIS EXPANSION KIT-XPAND NT SINGLE USE 6515624 CDM 272 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price IRIS EXPANSION KIT-XPAND NT SINGLE USE 6515624 CDM 272 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE EXPLANT TRUNCATED 60MM 65156700 CDM 272 RC facility both 3329 3329 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE EXPLANT TRUNCATED 60MM 65156700 CDM 272 RC facility both 3329 3329 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE EXPLANT FULL 60MM ZIMMER 65156701 CDM 272 RC facility both 3329 3329 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE EXPLANT FULL 60MM ZIMMER 65156701 CDM 272 RC facility both 3329 3329 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER EEA BLACK HANDLE SIZE 25MM 6515768 CDM 272 RC facility both 4173 4173 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER EEA BLACK HANDLE SIZE 25MM 6515768 CDM 272 RC facility both 4173 4173 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER EEA BLACK HANDLE SIZE 29MM 6515769 CDM 272 RC facility both 4173 4173 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER EEA BLACK HANDLE SIZE 29MM 6515769 CDM 272 RC facility both 4173 4173 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER EEA BLACK HANDLE SIZE 33MM 6515770 CDM 272 RC facility both 3126 3126 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER EEA BLACK HANDLE SIZE 33MM 6515770 CDM 272 RC facility both 3126 3126 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA 80-3.8 RELOAD 6515906 CDM 278 RC facility both 245 245 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA 80-3.8 RELOAD 6515906 CDM 278 RC facility both 245 245 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA 80-3.8 RELOADABLE HANDPIECE 6515907 CDM 278 RC facility both 470 470 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA 80-3.8 RELOADABLE HANDPIECE 6515907 CDM 278 RC facility both 470 470 Gross Charge Type: NIHD_Hosp_Profee_Price DAVINCI GRASPER CARDIERE 65159180 CDM 272 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price DAVINCI GRASPER CARDIERE 65159180 CDM 272 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0MM ACCUMED 65159211 CDM facility both 622 622 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0MM ACCUMED 65159211 CDM facility both 622 622 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL QUICK RELEASE ANTI ROTAT PEG 15/64 6515927 CDM 272 RC facility both 738 738 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL QUICK RELEASE ANTI ROTAT PEG 15/64 6515927 CDM 272 RC facility both 738 738 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE MARYLAND DISSECTOR DISP 6515935 CDM 272 RC facility both 1682 1682 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE MARYLAND DISSECTOR DISP 6515935 CDM 272 RC facility both 1682 1682 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.8MM QUICK RELEASE 65159515 CDM facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.8MM QUICK RELEASE 65159515 CDM facility both 672 672 Gross Charge Type: NIHD_Hosp_Profee_Price GELPOINT PATH PORT 65159801 CDM 272 RC facility both 2474 2474 Gross Charge Type: NIHD_Hosp_Profee_Price GELPOINT PATH PORT 65159801 CDM 272 RC facility both 2474 2474 Gross Charge Type: NIHD_Hosp_Profee_Price PUSHLOCK PERCUTANEOUS INSERTION KIT 65159803 CDM 278 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price PUSHLOCK PERCUTANEOUS INSERTION KIT 65159803 CDM 278 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL TIP 2.4 GUIDE PIN (BIOTENODESIS) 65159804 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL TIP 2.4 GUIDE PIN (BIOTENODESIS) 65159804 CDM 272 RC facility both 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price protamine 10 mg/mL Inj Sol [INYO] 6516 CDM J2720 HCPCS 63323-0229-05 NDC facility both 5 ML 330 330 Gross Charge Type: Pharmacy ACETABULAR SHELL 54MM SIZE JJ 6518060 CDM 278 RC facility both 10234 10234 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR SHELL 54MM SIZE JJ 6518060 CDM 278 RC facility both 10234 10234 Gross Charge Type: NIHD_Hosp_Profee_Price 65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL TechFee 652051 CDM 450 RC facility both 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price 65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL TechFee 652051 CDM 450 RC facility both 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price "65205 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL ProFee" 652052 CDM 982 RC 65205 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "65205 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL ProFee" 652052 CDM 982 RC 65205 HCPCS facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "65210 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL EMBEDDED (INCLUDES CONCRETIONS), S ProFee" 65210 CDM 982 RC 65210 HCPCS facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price "65210 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL EMBEDDED (INCLUDES CONCRETIONS), S ProFee" 65210 CDM 982 RC 65210 HCPCS facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price 65210 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR TechFee 652101 CDM 450 RC facility both 447 447 Gross Charge Type: NIHD_Hosp_Profee_Price 65210 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR TechFee 652101 CDM 450 RC facility both 447 447 Gross Charge Type: NIHD_Hosp_Profee_Price 65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP TechFee 652201 CDM 450 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price 65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP TechFee 652201 CDM 450 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price "65220 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT SLIT LAMP ProFee" 652203 CDM 982 RC 65220 HCPCS facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "65220 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT SLIT LAMP ProFee" 652203 CDM 982 RC 65220 HCPCS facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price 65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP TechFee 652221 CDM 450 RC facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price 65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP TechFee 652221 CDM 450 RC facility both 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price "65222 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLIT LAMP ProFee" 652222 CDM 982 RC 65222 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "65222 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLIT LAMP ProFee" 652222 CDM 982 RC 65222 HCPCS facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 8X3MM 6528027 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price PASSPORT BUTTON CANNULA 8X3MM 6528027 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIIOCOMPOSITE NTERFERENCE 10X28 6528065 CDM facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW BIIOCOMPOSITE NTERFERENCE 10X28 6528065 CDM facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price phenazopyridine 100 mg Tab [INYO] 6529 CDM 75826-0114-10 NDC facility both 1 EA 14.4 14.4 Gross Charge Type: Pharmacy | NDC EA = 1 TAB phenazopyridine 100 mg Tab [INYO] 6529 CDM 65162-0681-10 NDC facility both 1 EA 16.2 16.2 Gross Charge Type: Pharmacy | NDC EA = 1 TAB phenazopyridine 100 mg Tab [INYO] 6529 CDM 51293-0611-01 NDC facility both 1 EA 16.2 16.2 Gross Charge Type: Pharmacy | NDC EA = 1 TAB DRSG WOUND VAC SIMPLACE SMALL 6530989 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG WOUND VAC SIMPLACE SMALL 6530989 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price DERMABOND ADVANCED PEN (NEW) 6535001 CDM 271 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price DERMABOND ADVANCED PEN (NEW) 6535001 CDM 271 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY 16FRX30CC 6535019 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price CATH FOLEY 16FRX30CC 6535019 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price TISSEEL APPLICATION DUPLOCATH 35MM 6535051 CDM 272 RC facility both 179 179 Gross Charge Type: NIHD_Hosp_Profee_Price TISSEEL APPLICATION DUPLOCATH 35MM 6535051 CDM 272 RC facility both 179 179 Gross Charge Type: NIHD_Hosp_Profee_Price ELECT LOOP-HYSTERSCOPY 24 FR 6535056 CDM 272 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price ELECT LOOP-HYSTERSCOPY 24 FR 6535056 CDM 272 RC facility both 612 612 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE ROLLER HYSTEROSCOPY 6535057 CDM 272 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price ELECTRODE ROLLER HYSTEROSCOPY 6535057 CDM 272 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price INJECTOR VARICES DISP 25GX7FRX320CM 6535160 CDM 272 RC facility both 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price INJECTOR VARICES DISP 25GX7FRX320CM 6535160 CDM 272 RC facility both 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE SENSOR DULAL FLEX ST .035X15 6535173 CDM 272 RC C1769 HCPCS facility both 272 272 Gross Charge Type: NIHD_RHC_Price GUIDEWIRE SENSOR DULAL FLEX ST .035X15 6535173 CDM 272 RC C1769 HCPCS facility both 272 272 Gross Charge Type: NIHD_Clinic_Price GUIDEWIRE SENSOR DULAL FLEX ST .035X15 6535173 CDM 272 RC facility both 272 272 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE SENSOR DULAL FLEX ST .035X15 6535173 CDM 272 RC facility both 272 272 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE STRIP PLUS 1X5 BRN TP-1105 6535176 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE STRIP PLUS 1X5 BRN TP-1105 6535176 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 6-7-8 RIGI FLEX 6535181 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 6-7-8 RIGI FLEX 6535181 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 8-9-10 RIGI FLEX 6535182 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 8-9-10 RIGI FLEX 6535182 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 10-11-12 RIGIFLEX 6535183 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 10-11-12 RIGIFLEX 6535183 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 12-13.5-15 RIGIFLEX 6535184 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 12-13.5-15 RIGIFLEX 6535184 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 15-16.5-18 RIGIFLEX 6535185 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DIL 15-16.5-18 RIGIFLEX 6535185 CDM 272 RC facility both 1133 1133 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DILATOR 18-19-20 RIGIFLEX 6535186 CDM 272 RC facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price ESOPHAGEAL DILATOR 18-19-20 RIGIFLEX 6535186 CDM 272 RC facility both 912 912 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA TRI-STAPLE 45 STRA TIP 6535188 CDM 278 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA TRI-STAPLE 45 STRA TIP 6535188 CDM 278 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price CATH URET POLLACK OE FLEX 5FR 6535215 CDM 272 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price CATH URET POLLACK OE FLEX 5FR 6535215 CDM 272 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price URET BALLOON UROMAX 10CM 6535217 CDM 272 RC facility both 1362 1362 Gross Charge Type: NIHD_Hosp_Profee_Price URET BALLOON UROMAX 10CM 6535217 CDM 272 RC facility both 1362 1362 Gross Charge Type: NIHD_Hosp_Profee_Price ZIPWIRE ANGLED .035 X 150 6535219 CDM 272 RC facility both 200 200 Gross Charge Type: NIHD_Hosp_Profee_Price ZIPWIRE ANGLED .035 X 150 6535219 CDM 272 RC facility both 200 200 Gross Charge Type: NIHD_Hosp_Profee_Price CATH SUPRAPUBIC PERC STAMEY 12.0X30 6535234 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price CATH SUPRAPUBIC PERC STAMEY 12.0X30 6535234 CDM 278 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price BARD UROLOGIST TRAY DIFFICULT CATH (LAT 6535235 CDM 272 RC facility both 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price BARD UROLOGIST TRAY DIFFICULT CATH (LAT 6535235 CDM 272 RC facility both 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price CATH SUPRAPUBIC PERC MAC-LOC 12.0X25 6535236 CDM 278 RC facility both 252 252 Gross Charge Type: NIHD_Hosp_Profee_Price CATH SUPRAPUBIC PERC MAC-LOC 12.0X25 6535236 CDM 278 RC facility both 252 252 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY TUBE 16FR REPLACEMENT 6535239 CDM 272 RC facility both 382 382 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY TUBE 16FR REPLACEMENT 6535239 CDM 272 RC facility both 382 382 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA REFILL 30-3.5 6535266 CDM 278 RC facility both 1628 1628 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA REFILL 30-3.5 6535266 CDM 278 RC facility both 1628 1628 Gross Charge Type: NIHD_Hosp_Profee_Price CATH URETERAL OE 4FR LC 6535277 CDM 272 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price CATH URETERAL OE 4FR LC 6535277 CDM 272 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price CATH URETERAL OE 3FR LC 6535278 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CATH URETERAL OE 3FR LC 6535278 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BALLOON POSTPARTUM BAKRI 6535289 CDM 272 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price BALLOON POSTPARTUM BAKRI 6535289 CDM 272 RC facility both 840 840 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROGRIP LAP 16 X12CM 65353000 CDM 278 RC facility both 1612 1612 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROGRIP LAP 16 X12CM 65353000 CDM 278 RC facility both 1612 1612 Gross Charge Type: NIHD_Hosp_Profee_Price PEG 20F PONSKY PULL 6535304 CDM 278 RC facility both 1329 1329 Gross Charge Type: NIHD_Hosp_Profee_Price PEG 20F PONSKY PULL 6535304 CDM 278 RC facility both 1329 1329 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SEPRAMESH 8X12 6535336 CDM 278 RC facility both 7488 7488 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SEPRAMESH 8X12 6535336 CDM 278 RC facility both 7488 7488 Gross Charge Type: NIHD_Hosp_Profee_Price CAPIO CL TRANSVAGINAL SUTURE CAPTUR DEVI 6535354 CDM 272 RC facility both 5323 5323 Gross Charge Type: NIHD_Hosp_Profee_Price CAPIO CL TRANSVAGINAL SUTURE CAPTUR DEVI 6535354 CDM 272 RC facility both 5323 5323 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VICRYL WOVEN 12X12IN 6535355 CDM 278 RC facility both 5677 5677 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VICRYL WOVEN 12X12IN 6535355 CDM 278 RC facility both 5677 5677 Gross Charge Type: NIHD_Hosp_Profee_Price TUBING Y-SET AQUILEX OUTFLOW(MYOSURE) 65353600 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price TUBING Y-SET AQUILEX OUTFLOW(MYOSURE) 65353600 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA TRI-STAPLE 45 CURVE TIP 6535397 CDM 278 RC facility both 755 755 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA TRI-STAPLE 45 CURVE TIP 6535397 CDM 278 RC facility both 755 755 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO STITCH DEVICE 10MM 6535411 CDM 272 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO STITCH DEVICE 10MM 6535411 CDM 272 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price RECTAL FISTULA PLUG GORE BIO A 6535416 CDM 278 RC facility both 2526 2526 Gross Charge Type: NIHD_Hosp_Profee_Price RECTAL FISTULA PLUG GORE BIO A 6535416 CDM 278 RC facility both 2526 2526 Gross Charge Type: NIHD_Hosp_Profee_Price RESOLUTION CLIP DEVICE 2.8MMX235CM 6535417 CDM 272 RC facility both 781 781 Gross Charge Type: NIHD_Hosp_Profee_Price RESOLUTION CLIP DEVICE 2.8MMX235CM 6535417 CDM 272 RC facility both 781 781 Gross Charge Type: NIHD_Hosp_Profee_Price URET BALLOON UROMAX 4CM 6535441 CDM 272 RC facility both 1362 1362 Gross Charge Type: NIHD_Hosp_Profee_Price URET BALLOON UROMAX 4CM 6535441 CDM 272 RC facility both 1362 1362 Gross Charge Type: NIHD_Hosp_Profee_Price URET BALLOON UROMAX 6CM 6535442 CDM 272 RC facility both 1362 1362 Gross Charge Type: NIHD_Hosp_Profee_Price URET BALLOON UROMAX 6CM 6535442 CDM 272 RC facility both 1362 1362 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOCLIP 5MM III 6535474 CDM 278 RC facility both 1609 1609 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOCLIP 5MM III 6535474 CDM 278 RC facility both 1609 1609 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 15X10CM 6535478 CDM 278 RC facility both 1495 1495 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 15X10CM 6535478 CDM 278 RC facility both 1495 1495 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE PEAK PLASMA 3.0S (DR HARNESS) 65354879 CDM 272 RC facility both 1236 1236 Gross Charge Type: NIHD_Hosp_Profee_Price BLADE PEAK PLASMA 3.0S (DR HARNESS) 65354879 CDM 272 RC facility both 1236 1236 Gross Charge Type: NIHD_Hosp_Profee_Price SPEEDBAND SUPER 7 LIGATOR 6535488 CDM 272 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price SPEEDBAND SUPER 7 LIGATOR 6535488 CDM 272 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price MESH TVT KIT 810041 6535516 CDM 272 RC facility both 4300 4300 Gross Charge Type: NIHD_Hosp_Profee_Price MESH TVT KIT 810041 6535516 CDM 272 RC facility both 4300 4300 Gross Charge Type: NIHD_Hosp_Profee_Price TACKS FOR MESH 30 PROTACK 6535523 CDM 278 RC facility both 1410 1410 Gross Charge Type: NIHD_Hosp_Profee_Price TACKS FOR MESH 30 PROTACK 6535523 CDM 278 RC facility both 1410 1410 Gross Charge Type: NIHD_Hosp_Profee_Price I & A DISPOSABLE HANDPIECE 6535533 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price I & A DISPOSABLE HANDPIECE 6535533 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE PRECISE 6535543 CDM 272 RC facility both 1127 1127 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE PRECISE 6535543 CDM 272 RC facility both 1127 1127 Gross Charge Type: NIHD_Hosp_Profee_Price SONICISION 5MM CORDLESS DISSECTOR SCD39 6535546 CDM 272 RC facility both 2908 2908 Gross Charge Type: NIHD_Hosp_Profee_Price SONICISION 5MM CORDLESS DISSECTOR SCD39 6535546 CDM 272 RC facility both 2908 2908 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER PURSE STRING DEVICE 6535564 CDM 272 RC facility both 465 465 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER PURSE STRING DEVICE 6535564 CDM 272 RC facility both 465 465 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE ATLAS LS1037 6535571 CDM 272 RC facility both 743 743 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE ATLAS LS1037 6535571 CDM 272 RC facility both 743 743 Gross Charge Type: NIHD_Hosp_Profee_Price CANISTER KIT AQUILEX (MYOSURE) 6535588 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CANISTER KIT AQUILEX (MYOSURE) 6535588 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BASKET NITINOL ZERO TIP 4 WIRE 1.9FRX120 6535589 CDM 272 RC facility both 828 828 Gross Charge Type: NIHD_Hosp_Profee_Price BASKET NITINOL ZERO TIP 4 WIRE 1.9FRX120 6535589 CDM 272 RC facility both 828 828 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE ATLAS SHORT 1020 6535651 CDM 272 RC facility both 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE ATLAS SHORT 1020 6535651 CDM 272 RC facility both 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE DOLPHIN TIP 5MM(NO REORDER) 6535652 CDM 272 RC facility both 766 766 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE DOLPHIN TIP 5MM(NO REORDER) 6535652 CDM 272 RC facility both 766 766 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA TRI-STAPLE 30MMSTRA TIP 65356578 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA TRI-STAPLE 30MMSTRA TIP 65356578 CDM 278 RC facility both 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 1GRAM SHEET 6535665 CDM 270 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 1GRAM SHEET 6535665 CDM 270 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 10MM PRELOAD 6535666 CDM 250 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 10MM PRELOAD 6535666 CDM 250 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 5MM PRELOAD 6535667 CDM facility both 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 5MM PRELOAD 6535667 CDM facility both 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 5 GRAM 6535668 CDM 270 RC facility both 1575 1575 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 5 GRAM 6535668 CDM 270 RC facility both 1575 1575 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 1 GRAM 6535669 CDM 270 RC facility both 627 627 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 1 GRAM 6535669 CDM 270 RC facility both 627 627 Gross Charge Type: NIHD_Hosp_Profee_Price MESH TVT KIT EXACT TVTRL 6535677 CDM 272 RC facility both 4821 4821 Gross Charge Type: NIHD_Hosp_Profee_Price MESH TVT KIT EXACT TVTRL 6535677 CDM 272 RC facility both 4821 4821 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE SZ 20 6535688 CDM 272 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE SZ 20 6535688 CDM 272 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETEX 30X30CM 6535689 CDM 278 RC facility both 605 605 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETEX 30X30CM 6535689 CDM 278 RC facility both 605 605 Gross Charge Type: NIHD_Hosp_Profee_Price MESH TVTO KIT 810081 6535712 CDM facility both 5012 5012 Gross Charge Type: NIHD_Hosp_Profee_Price MESH TVTO KIT 810081 6535712 CDM facility both 5012 5012 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE SENSOR DUAL FLEX ST .038X150 6535742 CDM 272 RC facility both 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE SENSOR DUAL FLEX ST .038X150 6535742 CDM 272 RC facility both 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE AMPLATZ SUPER STIFF .038X185 6535747 CDM 272 RC C1769 HCPCS facility both 102 102 Gross Charge Type: NIHD_RHC_Price GUIDEWIRE AMPLATZ SUPER STIFF .038X185 6535747 CDM 272 RC C1769 HCPCS facility both 102 102 Gross Charge Type: NIHD_Clinic_Price GUIDEWIRE AMPLATZ SUPER STIFF .038X185 6535747 CDM 272 RC facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE AMPLATZ SUPER STIFF .038X185 6535747 CDM 272 RC facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE AMPLATZ SUPER STIFF .035X145 6535751 CDM 272 RC facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE AMPLATZ SUPER STIFF .035X145 6535751 CDM 272 RC facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER CONTOUR CV CUTTER (GREEN) 6535788 CDM 272 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER CONTOUR CV CUTTER (GREEN) 6535788 CDM 272 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price DRG PEEL AND PLACE PREVENA 20CM 65357894 CDM 272 RC facility both 691 691 Gross Charge Type: NIHD_Hosp_Profee_Price DRG PEEL AND PLACE PREVENA 20CM 65357894 CDM 272 RC facility both 691 691 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE MIC 26FR 6535791 CDM 272 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE MIC 26FR 6535791 CDM 272 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE MIC 28FR 6535792 CDM 272 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY FEEDING TUBE MIC 28FR 6535792 CDM 272 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price HARMONIC FOCUS 9CM CV SHEARS 6535793 CDM 272 RC facility both 1073 1073 Gross Charge Type: NIHD_Hosp_Profee_Price HARMONIC FOCUS 9CM CV SHEARS 6535793 CDM 272 RC facility both 1073 1073 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 180 ABSORB RELOAD 2-0 10CM 65358002 CDM 272 RC facility both 347 347 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 180 ABSORB RELOAD 2-0 10CM 65358002 CDM 272 RC facility both 347 347 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 180 ABSORB RELOAD 3-0 15CM 65358003 CDM 272 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 180 ABSORB RELOAD 3-0 15CM 65358003 CDM 272 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 2-0 REELS 65358004 CDM 272 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 2-0 REELS 65358004 CDM 272 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 3-0 REELS 65358005 CDM 272 RC facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 3-0 REELS 65358005 CDM 272 RC facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price ANAL FISTULA PLUG BIO DESIGN 6535801 CDM 278 RC facility both 3389 3389 Gross Charge Type: NIHD_Hosp_Profee_Price ANAL FISTULA PLUG BIO DESIGN 6535801 CDM 278 RC facility both 3389 3389 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 0 V-LOC 180 6IN 65358010 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 0 V-LOC 180 6IN 65358010 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 3-0 V-LOC 180 65358011 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 3-0 V-LOC 180 65358011 CDM 272 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSCOPY ROTH NET RETRIEVER GREEN 6535822 CDM 272 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSCOPY ROTH NET RETRIEVER GREEN 6535822 CDM 272 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSCOPY ROTH FOOD BOLUS SHORT GOLD 6535823 CDM 272 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSCOPY ROTH FOOD BOLUS SHORT GOLD 6535823 CDM 272 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSCOPY GUARDUS OVERTUBE 8.6 - 10.0 MM 6535824 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSCOPY GUARDUS OVERTUBE 8.6 - 10.0 MM 6535824 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSCOPY GUARDUS OVERTUBE 10.0 - 11.7MM 6535825 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSCOPY GUARDUS OVERTUBE 10.0 - 11.7MM 6535825 CDM 272 RC facility both 586 586 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETEX 15X10CM PPM1510X3 6535842 CDM 278 RC facility both 539 539 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PARIETEX 15X10CM PPM1510X3 6535842 CDM 278 RC facility both 539 539 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 2-0 ON GS-22 9IN 6535847 CDM 272 RC facility both 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 2-0 ON GS-22 9IN 6535847 CDM 272 RC facility both 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price NOVASURE DISPOSABLE DEVICE 6535850 CDM 272 RC facility both 3145 3145 Gross Charge Type: NIHD_Hosp_Profee_Price NOVASURE DISPOSABLE DEVICE 6535850 CDM 272 RC facility both 3145 3145 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE BLUNT TIP LF1837 6535870 CDM 272 RC facility both 1528 1528 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE BLUNT TIP LF1837 6535870 CDM 272 RC facility both 1528 1528 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX ST 6.4MM 6535879 CDM 278 RC facility both 4028 4028 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX ST 6.4MM 6535879 CDM 278 RC facility both 4028 4028 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX ST 4.3MM 6535880 CDM 278 RC facility both 2921 2921 Gross Charge Type: NIHD_Hosp_Profee_Price MESH VENTRALEX ST 4.3MM 6535880 CDM 278 RC facility both 2921 2921 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE IMPACT LF4418 6535881 CDM 272 RC facility both 1980 1980 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE IMPACT LF4418 6535881 CDM 272 RC facility both 1980 1980 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE SM JAW LF1212A 6535892 CDM 272 RC facility both 1294 1294 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE SM JAW LF1212A 6535892 CDM 272 RC facility both 1294 1294 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROCEED VENTRAL PATCH 6.4CM 6535899 CDM 278 RC facility both 2656 2656 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PROCEED VENTRAL PATCH 6.4CM 6535899 CDM 278 RC facility both 2656 2656 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE AMPLATZ SUPER STIFF .035X260 6535909 CDM 272 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE AMPLATZ SUPER STIFF .035X260 6535909 CDM 272 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price RETRACTOR ALEXIS CONTAINED EXTRACTION 65359214 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price RETRACTOR ALEXIS CONTAINED EXTRACTION 65359214 CDM 272 RC facility both 975 975 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG AQUACEL AG SURGICAL 3 1/2X 12 I 6535952 CDM 272 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG AQUACEL AG SURGICAL 3 1/2X 12 I 6535952 CDM 272 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG AQUACEL AG SURGICAL 3 1/2X 10 I 6535953 CDM 272 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price DRSG AQUACEL AG SURGICAL 3 1/2X 10 I 6535953 CDM 272 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price MYOSURE CLASSIC DISPOSABLE DEVICE 6535958 CDM 272 RC facility both 2784 2784 Gross Charge Type: NIHD_Hosp_Profee_Price MYOSURE CLASSIC DISPOSABLE DEVICE 6535958 CDM 272 RC facility both 2784 2784 Gross Charge Type: NIHD_Hosp_Profee_Price MYOSURE LITE TISSUE REMOVAL DEVICE 6535959 CDM 272 RC facility both 1500 1500 Gross Charge Type: NIHD_Hosp_Profee_Price MYOSURE LITE TISSUE REMOVAL DEVICE 6535959 CDM 272 RC facility both 1500 1500 Gross Charge Type: NIHD_Hosp_Profee_Price MYOSURE XL TISSUE REMOVAL DEVICE 6535960 CDM 272 RC facility both 2829 2829 Gross Charge Type: NIHD_Hosp_Profee_Price MYOSURE XL TISSUE REMOVAL DEVICE 6535960 CDM 272 RC facility both 2829 2829 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 1/2 GRAM 6535968 CDM 250 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price AVITENE COLLAGEN FLOUR 1/2 GRAM 6535968 CDM 250 RC facility both 270 270 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY PEG KIT SZ 20 F 6535973 CDM 272 RC facility both 274 274 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY PEG KIT SZ 20 F 6535973 CDM 272 RC facility both 274 274 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY KIT T-FASTENER 24 FR MIC 6535987 CDM 278 RC facility both 617 617 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROSTOMY KIT T-FASTENER 24 FR MIC 6535987 CDM 278 RC facility both 617 617 Gross Charge Type: NIHD_Hosp_Profee_Price labetalol 100 mg Tab [INYO] 6536 CDM 00904-7109-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB labetalol 100 mg Tab [INYO] 6536 CDM 00904-5928-61 NDC facility both 1 EA 13.69 13.69 Gross Charge Type: Pharmacy | NDC EA = 1 TAB labetalol 100 mg Tab [INYO] 6536 CDM 68382-0798-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "RING PESSARY W/ SUPPORT RING SZ 5 3""" 6536010 CDM facility both 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price "RING PESSARY W/ SUPPORT RING SZ 5 3""" 6536010 CDM facility both 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price "RING PESSARY W/ SUPPORT RING 2 3/4"" SZ4" 6536011 CDM facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price "RING PESSARY W/ SUPPORT RING 2 3/4"" SZ4" 6536011 CDM facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price "RING PESSARY W/ SUPPORT RING SZ#5 3""" 6536012 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "RING PESSARY W/ SUPPORT RING SZ#5 3""" 6536012 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DONUT FLIXIBLE PESSARY 2 1/2 6536013 CDM facility both 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price DONUT FLIXIBLE PESSARY 2 1/2 6536013 CDM facility both 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price GELLHORN PESSARY WITH STEM SIZE 2 1/4 SP 6536014 CDM facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price GELLHORN PESSARY WITH STEM SIZE 2 1/4 SP 6536014 CDM facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price GELLHORN PESSARY WITH STEM SIZE 4 6536015 CDM facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price GELLHORN PESSARY WITH STEM SIZE 4 6536015 CDM facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price DONUT PESSARY SIZE 3 1/4 6536020 CDM facility both 155 155 Gross Charge Type: NIHD_Hosp_Profee_Price DONUT PESSARY SIZE 3 1/4 6536020 CDM facility both 155 155 Gross Charge Type: NIHD_Hosp_Profee_Price HOVER MATT SINGLE PATIENT USE 6536066 CDM 271 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price HOVER MATT SINGLE PATIENT USE 6536066 CDM 271 RC facility both 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER KUMAR CHOLANGIOGRAPHY 6536074 CDM 278 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER KUMAR CHOLANGIOGRAPHY 6536074 CDM 278 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 14 6536111 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 14 6536111 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 16 6536122 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 16 6536122 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 18 6536133 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 18 6536133 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 10 6536144 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 10 6536144 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 12 6536155 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 12 6536155 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price PROBE GOLD INJECT/CAUTERY 2.3MMX210 6536197 CDM 272 RC facility both 1197 1197 Gross Charge Type: NIHD_Hosp_Profee_Price PROBE GOLD INJECT/CAUTERY 2.3MMX210 6536197 CDM 272 RC facility both 1197 1197 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 26 6536678 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 26 6536678 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price labetalol 100 mg/ 20 mL Sol [INYO] 6538 CDM J1920 HCPCS 72266-0102-01 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy labetalol 100 mg/ 20 mL Sol [INYO] 6538 CDM J1920 HCPCS 72611-0734-01 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy labetalol 100 mg/ 20 mL Sol [INYO] 6538 CDM J1920 HCPCS 00409-2267-20 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy labetalol 100 mg/ 20 mL Sol [INYO] 6538 CDM J1920 HCPCS 36000-0322-02 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy labetalol 100 mg/ 20 mL Sol [INYO] 6538 CDM J1920 HCPCS 00143-9622-01 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy labetalol 100 mg/ 20 mL Sol [INYO] 6538 CDM J1920 HCPCS 47781-0586-29 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy quiNIDine 80 mg/mL Inj Sol [INYO] 6539 CDM 00002-1407-01 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy SUTURE BIOSYN 2-0 V-20 6540011 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE BIOSYN 2-0 V-20 6540011 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE CHROMIC GUT 3-0 GS-21 6540040 CDM 278 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE CHROMIC GUT 3-0 GS-21 6540040 CDM 278 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE MONOSOF 4-0 C-13 (CE4) 6540108 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE MONOSOF 4-0 C-13 (CE4) 6540108 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 8-0 BV130-4 6540324 CDM 272 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 8-0 BV130-4 6540324 CDM 272 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price SURGICLIP CLIP APPLIERS M-11.5 6541012 CDM 272 RC facility both 278 278 Gross Charge Type: NIHD_Hosp_Profee_Price SURGICLIP CLIP APPLIERS M-11.5 6541012 CDM 272 RC facility both 278 278 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA ROTICULAT 30-2.5 REFILL 6541020 CDM 278 RC facility both 287 287 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA ROTICULAT 30-2.5 REFILL 6541020 CDM 278 RC facility both 287 287 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA UNIVERSAL ULTRA HANDPIE 6541021 CDM 272 RC facility both 1468 1468 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA UNIVERSAL ULTRA HANDPIE 6541021 CDM 272 RC facility both 1468 1468 Gross Charge Type: NIHD_Hosp_Profee_Price CAPIO SUTURE POLYGLYCOLIC 0 65410221 CDM 272 RC facility both 95 95 Gross Charge Type: NIHD_Hosp_Profee_Price CAPIO SUTURE POLYGLYCOLIC 0 65410221 CDM 272 RC facility both 95 95 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA REFILL 45-3.5 6541034 CDM 278 RC facility both 652 652 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA REFILL 45-3.5 6541034 CDM 278 RC facility both 652 652 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER LAP COLON EEA SZ 28 6541047 CDM 272 RC facility both 1031 1031 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER LAP COLON EEA SZ 28 6541047 CDM 272 RC facility both 1031 1031 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER LAP COLON EEA SZ 31 6541048 CDM 272 RC facility both 2066 2066 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER LAP COLON EEA SZ 31 6541048 CDM 272 RC facility both 2066 2066 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER SKIN WIDE 6541250 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER SKIN WIDE 6541250 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TA 30-3.5 MULIFIRE 6541278 CDM 278 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TA 30-3.5 MULIFIRE 6541278 CDM 278 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TA 30-4.8 L MULTIFIRE 6541280 CDM 278 RC facility both 2206 2206 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TA 30-4.8 L MULTIFIRE 6541280 CDM 278 RC facility both 2206 2206 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TA 60-3.5 MULTIFIRE 6541281 CDM 278 RC facility both 314 314 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TA 60-3.5 MULTIFIRE 6541281 CDM 278 RC facility both 314 314 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TA 90-4.8 L MULTIFIRE 6541283 CDM 278 RC facility both 8000 8000 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER TA 90-4.8 L MULTIFIRE 6541283 CDM 278 RC facility both 8000 8000 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA DST 60-3.8 RELOADABLE HANDPI 6541285 CDM 278 RC facility both 1206 1206 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA DST 60-3.8 RELOADABLE HANDPI 6541285 CDM 278 RC facility both 1206 1206 Gross Charge Type: NIHD_Hosp_Profee_Price SURGITIE LIGATING LOOP 0 POLYSORB 6541298 CDM 272 RC facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price SURGITIE LIGATING LOOP 0 POLYSORB 6541298 CDM 272 RC facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA REFILL 60-3.5 6541300 CDM 278 RC facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ENDO GIA REFILL 60-3.5 6541300 CDM 278 RC facility both 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 8.0 TG-140-8 6541312 CDM 272 RC facility both 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 8.0 TG-140-8 6541312 CDM 272 RC facility both 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 7.0 TG-140-8 6541314 CDM 272 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 7.0 TG-140-8 6541314 CDM 272 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 6-0 S-28 6541318 CDM 272 RC facility both 117 117 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VICRYL 6-0 S-28 6541318 CDM 272 RC facility both 117 117 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA 80-4.8 RELOADABLE HANDPIECE 6541320 CDM 278 RC facility both 529 529 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA 80-4.8 RELOADABLE HANDPIECE 6541320 CDM 278 RC facility both 529 529 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER LAP COLON CEEA 21 6541325 CDM 278 RC facility both 2017 2017 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER LAP COLON CEEA 21 6541325 CDM 278 RC facility both 2017 2017 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ROTICULAR TA 55-3.5 6541334 CDM 278 RC facility both 536 536 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER ROTICULAR TA 55-3.5 6541334 CDM 278 RC facility both 536 536 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 0 ON GS-21 9 IN LONG 6541353 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 0 ON GS-21 9 IN LONG 6541353 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE 0 VLOC 180 GS-21 6 INCHES 6541359 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE 0 VLOC 180 GS-21 6 INCHES 6541359 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA DST 60-3.8 REFILL 6541378 CDM 278 RC facility both 642 642 Gross Charge Type: NIHD_Hosp_Profee_Price STAPLER GIA DST 60-3.8 REFILL 6541378 CDM 278 RC facility both 642 642 Gross Charge Type: NIHD_Hosp_Profee_Price SURGITIE LIGATING LOOP 2-0 SURGIDAC 6541394 CDM 272 RC facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price SURGITIE LIGATING LOOP 2-0 SURGIDAC 6541394 CDM 272 RC facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SEPRAMESH 3X6 6541705 CDM 278 RC facility both 2088 2088 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SEPRAMESH 3X6 6541705 CDM 278 RC facility both 2088 2088 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE CHROMIC 2.0 6541890 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE CHROMIC 2.0 6541890 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CMC THUMB BRACE FOR RELIEF RIGHT SIZE 3 6542741 CDM 274 RC L3924 HCPCS facility both 317 317 Gross Charge Type: NIHD_RHC_Price CMC THUMB BRACE FOR RELIEF RIGHT SIZE 3 6542741 CDM 274 RC L3924 HCPCS facility both 317 317 Gross Charge Type: NIHD_Clinic_Price CMC THUMB BRACE FOR RELIEF RIGHT SIZE 3 6542741 CDM 274 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price CMC THUMB BRACE FOR RELIEF RIGHT SIZE 3 6542741 CDM 274 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price nicotine 21 mg/24 hr Transderm ER Film [INYO] 6550 CDM 43598-0448-74 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES nicotine 21 mg/24 hr Transderm ER Film [INYO] 6550 CDM 43598-0448-28 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES niCARdipine 2.5 mg/mL Inj Sol [INYO] 6552 CDM 00143-9689-10 NDC facility both 10 ML 244.99 244.99 Gross Charge Type: Pharmacy rifampin 300 mg Cap [INYO] 6561 CDM 00904-5282-61 NDC facility both 1 EA 7.96 7.96 Gross Charge Type: Pharmacy | NDC EA = 1 CAP rifampin 300 mg Cap [INYO] 6561 CDM 60687-0586-01 NDC facility both 1 EA 8.18 8.18 Gross Charge Type: Pharmacy | NDC EA = 1 CAP rocuronium 50 mg/5 mL Sol [INYO] 6562 CDM J3490 HCPCS 39822-4200-02 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy rocuronium 50 mg/5 mL IV Sol [INYO] 6562 CDM J3490 HCPCS 63323-0426-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy rocuronium 50 mg/5 mL IV Sol [INYO] 6562 CDM J3490 HCPCS 55150-0225-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy rocuronium 50 mg/5 mL IV Sol [INYO] 6562 CDM J3490 HCPCS 00409-9558-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy rocuronium 50 mg/5 mL IV Sol [INYO] 6562 CDM J3490 HCPCS 72611-0756-10 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy rocuronium 50 mg/5 mL IV Sol [INYO] 6562 CDM J3490 HCPCS 25021-0662-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy APOLLO WAND RADIO FREQUENCY 6567002 CDM 272 RC facility both 738 738 Gross Charge Type: NIHD_Hosp_Profee_Price APOLLO WAND RADIO FREQUENCY 6567002 CDM 272 RC facility both 738 738 Gross Charge Type: NIHD_Hosp_Profee_Price methocarbamol 100 mg/mL Sol Inj [INYO] 6570 CDM J2800 HCPCS 63323-0778-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy methocarbamol 100 mg/mL Inj Sol [INYO] 6570 CDM J2800 HCPCS 70069-0101-25 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy methocarbamol 100 mg/mL Inj Sol [INYO] 6570 CDM J2800 HCPCS 00641-6103-25 NDC facility both 10 ML 268.8 268.8 Gross Charge Type: Pharmacy TAPE LABRAL BLACK AND WHITE 6575789 CDM 272 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price TAPE LABRAL BLACK AND WHITE 6575789 CDM 272 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price EZ- IO 15MM NEEDLE TRAINING SET 6590004 CDM facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price EZ- IO 15MM NEEDLE TRAINING SET 6590004 CDM facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price EZ-IO 15G X 15MM NEEDLE SETS 6590005 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price EZ-IO 15G X 15MM NEEDLE SETS 6590005 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price EZ-IO 15G X 25MM NEEDLE SETS 6590006 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price EZ-IO 15G X 25MM NEEDLE SETS 6590006 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price EZ-IO 15G X 45MM NEEDLE SETS 6590007 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price EZ-IO 15G X 45MM NEEDLE SETS 6590007 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price scopolamine 1 mg/72 hr [INYO] 6597 CDM 50742-0505-04 NDC facility both 1 EA 101 101 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES scopolamine 1 mg/72 hr [INYO] 6597 CDM 10019-0553-03 NDC facility both 1 EA 127.78 127.78 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES ACETABULAR LINER NEUTRAL 36MM SIZE NN 66010712 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price ACETABULAR LINER NEUTRAL 36MM SIZE NN 66010712 CDM 278 RC facility both 6776 6776 Gross Charge Type: NIHD_Hosp_Profee_Price HYSTERO CATH 5.5F X 40CM 6605040 CDM 272 RC C1726 HCPCS facility both 110 110 Gross Charge Type: NIHD_RHC_Price HYSTERO CATH 5.5F X 40CM 6605040 CDM 272 RC C1726 HCPCS facility both 110 110 Gross Charge Type: NIHD_Clinic_Price HYSTERO CATH 5.5F X 40CM 6605040 CDM 272 RC facility both 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price HYSTERO CATH 5.5F X 40CM 6605040 CDM 272 RC facility both 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price doxepin 25 mg Cap [INYO] 6612 CDM 00904-6971-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP doxepin 25 mg Cap [INYO] 6612 CDM 00904-7053-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP doxepin 25 mg Cap [INYO] 6612 CDM 00378-3125-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP hydrocortisone 100 mg preservative-free Pow [INYO] 6626 CDM J1720 HCPCS 00009-0011-04 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy hydrocortisone 100 mg preservative-free Pow [INYO] 6626 CDM J1720 HCPCS 00009-0011-03 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy methylPREDNISolone sodium succinate 40 mg preservative-free Pow [INYO] 6630 CDM J2919 HCPCS 00009-0039-28 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy methylPREDNISolone sodium succinate 125 mg preservative-free Pow [INYO] 6631 CDM J2919 HCPCS 00009-0047-22 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy acyclovir Top 5% Oint [INYO] 6649 CDM 00378-8700-06 NDC facility both 1 EA 1595.2 1595.2 Gross Charge Type: Pharmacy | NDC EA = 15 APP acyclovir 200 mg Cap [INYO] 6651 CDM 00904-5789-61 NDC facility both 1 EA 9.17 9.17 Gross Charge Type: Pharmacy | NDC EA = 1 CAP acyclovir 200 mg Cap [INYO] 6651 CDM 50268-0060-15 NDC facility both 1 EA 15.31 15.31 Gross Charge Type: Pharmacy | NDC EA = 1 CAP AKREOS AO60 21.5 BUNDLE 66514758 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 21.5 BUNDLE 66514758 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price SUMAtriptan 25 mg Tab [INYO] 6658 CDM 63304-0097-19 NDC facility both 1 EA 141.25 141.25 Gross Charge Type: Pharmacy | NDC EA = 1 TAB SUMAtriptan 25 mg Tab [INYO] 6658 CDM 65862-0146-36 NDC facility both 1 EA 135.26 135.26 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pseudoephedrine 60 mg Tab [INYO] 6660 CDM 00904-6907-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB DRESSING ALLEVYN LIFE 21CM X 21CM 6680107 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING ALLEVYN LIFE 21CM X 21CM 6680107 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price pentamidine 300 mg Inj [INYO] 6698 CDM 63323-0113-10 NDC facility both 1 EA 1520 1520 Gross Charge Type: Pharmacy GUIDEWIRE NITINOL STRAIGHT TIP .035X150 6703050 CDM 272 RC facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRE NITINOL STRAIGHT TIP .035X150 6703050 CDM 272 RC facility both 212 212 Gross Charge Type: NIHD_Hosp_Profee_Price "67105 Repair, retinal detachment; photocoagulation, w/wo drainage subretinal fluid" 67105 CDM 361 RC 67105 HCPCS facility both 3406 3406 Gross Charge Type: NIHD_Hosp_Profee_Price "67105 Repair, retinal detachment; photocoagulation, w/wo drainage subretinal fluid" 67105 CDM 361 RC 67105 HCPCS facility both 3406 3406 Gross Charge Type: NIHD_Hosp_Profee_Price HARMONY™ BREASTPUMP 6718600 CDM 271 RC E0603 HCPCS facility both 58 58 Gross Charge Type: NIHD_RHC_Price HARMONY™ BREASTPUMP 6718600 CDM 271 RC E0603 HCPCS facility both 58 58 Gross Charge Type: NIHD_Clinic_Price HARMONY™ BREASTPUMP 6718600 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price HARMONY™ BREASTPUMP 6718600 CDM 271 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 67228 ARGON LASER OPTH PROC CHARGE 67228 CDM 361 RC facility both 2558 2558 Gross Charge Type: NIHD_Hosp_Profee_Price 67228 ARGON LASER OPTH PROC CHARGE 67228 CDM 361 RC facility both 2558 2558 Gross Charge Type: NIHD_Hosp_Profee_Price tetracycline 500 mg Cap [INYO] 6744 CDM 00172-2407-60 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Therapeutic Multiple Vitamins Tab [INYO] 6759 CDM 00904-0539-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB thiamine 100 mg Tab [INYO] 6767 CDM 50268-0851-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB thiamine 100 mg Tab [INYO] 6767 CDM 68094-0116-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB thiamine 100 mg Tab [INYO] 6767 CDM 77333-0934-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 67700 ED DRAINAGE OF EYELID ABSCESS TechFee 677001 CDM 450 RC facility both 544 544 Gross Charge Type: NIHD_Hosp_Profee_Price 67700 ED DRAINAGE OF EYELID ABSCESS TechFee 677001 CDM 450 RC facility both 544 544 Gross Charge Type: NIHD_Hosp_Profee_Price Drainage Eyelid Abscess Charge 677002 CDM 761 RC facility both 544 544 Gross Charge Type: NIHD_Hosp_Profee_Price Drainage Eyelid Abscess Charge 677002 CDM 761 RC facility both 544 544 Gross Charge Type: NIHD_Hosp_Profee_Price "67700 BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID ProFee" 677003 CDM 982 RC 67700 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "67700 BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID ProFee" 677003 CDM 982 RC 67700 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price chlorproMAZINE 25 mg/mL Inj Sol [INYO] 6773 CDM J3230 HCPCS 00641-1397-35 NDC facility both 1 ML 277.33 277.33 Gross Charge Type: Pharmacy "67900 REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH) ProFee" 67900 CDM 982 RC 67900 HCPCS facility both 883 883 Gross Charge Type: NIHD_Hosp_Profee_Price "67900 REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH) ProFee" 67900 CDM 982 RC 67900 HCPCS facility both 883 883 Gross Charge Type: NIHD_Hosp_Profee_Price "67917 REPAIR OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS) ProFee" 67917 CDM 982 RC 67917 HCPCS facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price "67917 REPAIR OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS) ProFee" 67917 CDM 982 RC 67917 HCPCS facility both 690 690 Gross Charge Type: NIHD_Hosp_Profee_Price "67938 REMOVAL OF EMBEDDED FOREIGN BODY, EYELID ProFee" 67938 CDM 982 RC 67938 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "67938 REMOVAL OF EMBEDDED FOREIGN BODY, EYELID ProFee" 67938 CDM 982 RC 67938 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 67950 CANTHOPLASTY (RECONSTRUCTION OF CANTHUS) ProFee 67950 CDM 982 RC 67950 HCPCS facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price 67950 CANTHOPLASTY (RECONSTRUCTION OF CANTHUS) ProFee 67950 CDM 982 RC 67950 HCPCS facility both 808 808 Gross Charge Type: NIHD_Hosp_Profee_Price vecuronium 10 mg IV Inj [INYO] 6800 CDM 00409-1632-01 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy vecuronium 10 mg IV Inj [INYO] 6800 CDM 67457-0438-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy vecuronium 10 mg IV Inj [INYO] 6800 CDM 00703-2914-03 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy I&D Eyelid Lining Charge 68020 CDM 761 RC facility both 1361 1361 Gross Charge Type: NIHD_Hosp_Profee_Price I&D Eyelid Lining Charge 68020 CDM 761 RC facility both 1361 1361 Gross Charge Type: NIHD_Hosp_Profee_Price 68200 Subconjunctival injection 68200 CDM 521 RC 68200 HCPCS facility both 371 371 Gross Charge Type: NIHD_Clinic_Price witch hazel topical 50% [INYO] 6841 CDM 50289-3250-01 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 40 APP witch hazel topical 50% [INYO] 6841 CDM 50289-9250-05 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 40 APP witch hazel topical 50% [INYO] 6841 CDM 37379-0020-00 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 40 APP VELOSORB 4-0 UD 30 V-20 6847026 CDM 272 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price VELOSORB 4-0 UD 30 V-20 6847026 CDM 272 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price RING PESSARY W/ SUPPORT RING SZ 3 6857880 CDM facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price RING PESSARY W/ SUPPORT RING SZ 3 6857880 CDM facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price bethanechol 25 mg Tab [INYO] 6868 CDM 00904-6178-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bethanechol 25 mg Tab [INYO] 6868 CDM 00832-0512-89 NDC facility both 1 EA 16.08 16.08 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bethanechol 25 mg Tab [INYO] 6868 CDM 00832-0512-01 NDC facility both 1 EA 16.02 16.02 Gross Charge Type: Pharmacy | NDC EA = 1 TAB diazepam 5 mg Tab [INYO] 6876 CDM 51079-0285-20 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB diazepam 5 mg Tab [INYO] 6876 CDM 00904-5880-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB betamethasone Top valerate 0.1% Crm [INYO] 6883 CDM 00472-0370-15 NDC facility both 1 EA 139.9 139.9 Gross Charge Type: Pharmacy | NDC EA = 15 APP betamethasone Top valerate 0.1% Crm [INYO] 6883 CDM 00713-0326-15 NDC facility both 1 EA 111.85 111.85 Gross Charge Type: Pharmacy | NDC EA = 15 APP betamethasone Top valerate 0.1% Crm [INYO] 6883 CDM 00168-0040-15 NDC facility both 1 EA 139.85 139.85 Gross Charge Type: Pharmacy | NDC EA = 15 APP verapamil 180 mg ER Tab [INYO] 6891 CDM 68462-0293-01 NDC facility both 1 EA 8.64 8.64 Gross Charge Type: Pharmacy | NDC EA = 1 TAB verapamil 180 mg ER Tab [INYO] 6891 CDM 51079-0899-20 NDC facility both 1 EA 14.95 14.95 Gross Charge Type: Pharmacy | NDC EA = 1 TAB verapamil 80 mg IR Tab [INYO] 6892 CDM 00904-2920-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB verapamil 2.5 mg/mL IV Sol [INYO] 6895 CDM 51754-0205-02 NDC facility both 4 ML 279.36 279.36 Gross Charge Type: Pharmacy verapamil 2.5 mg/mL IV Sol [INYO] 6895 CDM 70121-1586-03 NDC facility both 4 ML 264 264 Gross Charge Type: Pharmacy verapamil 2.5 mg/mL IV Sol [INYO] 6895 CDM 55150-0343-05 NDC facility both 4 ML 288 288 Gross Charge Type: Pharmacy verapamil 2.5 mg/mL IV Sol [INYO] 6895 CDM 70710-1644-05 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy verapamil 2.5 mg/mL IV Sol [INYO] 6895 CDM 72485-0109-05 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy verapamil 120 mg ER Tab [INYO] 6897 CDM 68462-0292-01 NDC facility both 1 EA 6.44 6.44 Gross Charge Type: Pharmacy | NDC EA = 1 TAB verapamil 120 mg ER Tab [INYO] 6897 CDM 60687-0493-01 NDC facility both 1 EA 10.14 10.14 Gross Charge Type: Pharmacy | NDC EA = 1 TAB verapamil 120 mg ER Tab [INYO] 6897 CDM 51079-0894-20 NDC facility both 1 EA 13.9 13.9 Gross Charge Type: Pharmacy | NDC EA = 1 TAB vasopressin 20 units/mL Sol [INYO] 6900 CDM J2598 HCPCS 70121-1642-05 NDC facility both 1 ML 1009.01 1009.01 Gross Charge Type: Pharmacy vasopressin 20 units/mL [INYO] 6900 CDM J2598 HCPCS 42023-0164-25 NDC facility both 1 ML 1520 1520 Gross Charge Type: Pharmacy vasopressin 20 units/mL Sol [INYO] 6900 CDM J2598 HCPCS 55150-0371-25 NDC facility both 1 ML 1520 1520 Gross Charge Type: Pharmacy 69000 DRAIN EXT EAR ABSC/HEMAT SMPL CHARGE 69000 CDM 761 RC facility both 1024 1024 Gross Charge Type: NIHD_Hosp_Profee_Price 69000 DRAIN EXT EAR ABSC/HEMAT SMPL CHARGE 69000 CDM 761 RC facility both 1024 1024 Gross Charge Type: NIHD_Hosp_Profee_Price 69000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPL 690001 CDM 450 RC facility both 1024 1024 Gross Charge Type: NIHD_Hosp_Profee_Price 69000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPL 690001 CDM 450 RC facility both 1024 1024 Gross Charge Type: NIHD_Hosp_Profee_Price "69000 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE ProFee" 690002 CDM 982 RC 69000 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "69000 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE ProFee" 690002 CDM 982 RC 69000 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 69005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX TechFee 690051 CDM 450 RC facility both 4229 4229 Gross Charge Type: NIHD_Hosp_Profee_Price 69005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX TechFee 690051 CDM 450 RC facility both 4229 4229 Gross Charge Type: NIHD_Hosp_Profee_Price 69005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX CHARGE 690052 CDM 761 RC facility both 4229 4229 Gross Charge Type: NIHD_Hosp_Profee_Price 69005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX CHARGE 690052 CDM 761 RC facility both 4229 4229 Gross Charge Type: NIHD_Hosp_Profee_Price "BARIUM, SUSP,40% VARIBAR HONEY BRACEZ" 6909810 CDM facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price "BARIUM, SUSP,40% VARIBAR HONEY BRACEZ" 6909810 CDM facility both 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price 69200 Removal foreign body from external auditory canal; without general anesthesia 692001 CDM 521 RC 69200 HCPCS facility both 168 168 Gross Charge Type: NIHD_RHC_Price 69200 Removal foreign body from external auditory canal; without general anesthesia 692001 CDM 521 RC 69200 HCPCS facility both 163 163 Gross Charge Type: NIHD_Clinic_Price 69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES TechFee 692002 CDM 450 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES TechFee 692002 CDM 450 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 69200 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA ProFee 692003 CDM 982 RC 69200 HCPCS facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price 69200 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA ProFee 692003 CDM 982 RC 69200 HCPCS facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price 69209 Ear Irrigation POC 692091 CDM 521 RC 69209 HCPCS facility both 28 28 Gross Charge Type: NIHD_RHC_Price 69209 Ear Irrigation POC 692091 CDM 521 RC 69209 HCPCS facility both 28 28 Gross Charge Type: NIHD_Clinic_Price Ear Irrigation POC 692092 CDM 521 RC 69209 HCPCS facility both 27 27 Gross Charge Type: NIHD_RHC_Price Ear Irrigation POC 692092 CDM 521 RC 69209 HCPCS facility both 27 27 Gross Charge Type: NIHD_Clinic_Price Ear Irrigation POC 692092 CDM 521 RC facility both 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price Ear Irrigation POC 692092 CDM 521 RC facility both 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price Ear Irrigation Clinic POC (RE) 6920923 CDM 69209 HCPCS facility both 27 27 Gross Charge Type: NIHD_Clinic_Price "69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL Pro" 692094 CDM 69209 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price "69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL Pro" 692094 CDM 69209 HCPCS facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price "69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL TechFee" 692095 CDM 450 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price "69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL TechFee" 692095 CDM 450 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price "69210 Removal impacted cerumen requiring instrumentation, unilateral" 692101 CDM 521 RC 69210 HCPCS facility both 274 274 Gross Charge Type: NIHD_RHC_Price "69210 Removal impacted cerumen requiring instrumentation, unilateral" 692101 CDM 521 RC 69210 HCPCS facility both 140 140 Gross Charge Type: NIHD_Clinic_Price 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee 692101 CDM 450 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee 692101 CDM 450 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price "69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL ProFee" 692102 CDM 982 RC 69210 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price "69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL ProFee" 692102 CDM 982 RC 69210 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price vitamin E 400 intl units Cap [INYO] 6924 CDM 00904-0274-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP hydrOXYzine hydrochloride 25 mg Tab [INYO] 6927 CDM 00904-6617-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrOXYzine hydrochloride 25 mg Tab [INYO] 6927 CDM 23155-0501-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lidocaine topical 5% Oin [inyo] 6947 CDM 70752-0113-03 NDC facility both 1 EA 1266.72 1266.72 Gross Charge Type: Pharmacy | NDC EA = 35.44 APP lidocaine Top 5% Oint [INYO] 6947 CDM 68462-0418-20 NDC facility both 1 EA 1266.64 1266.64 Gross Charge Type: Pharmacy | NDC EA = 35.44 APP lidocaine Top 5% Oint [INYO] 6947 CDM 65162-0918-38 NDC facility both 1 EA 1200 1200 Gross Charge Type: Pharmacy | NDC EA = 35.44 APP lidocaine Top 5% Oint [INYO] 6947 CDM 65162-0918-53 NDC facility both 1 EA 1080.01 1080.01 Gross Charge Type: Pharmacy | NDC EA = 35.44 APP lidocaine Top 5% Oint [INYO] 6947 CDM 52565-0008-14 NDC facility both 1 EA 1266.64 1266.64 Gross Charge Type: Pharmacy | NDC EA = 35.44 APP lidocaine topical 2% Sol [INYO] 6953 CDM 00121-4950-40 NDC facility both 15 ML 33.64 33.64 Gross Charge Type: Pharmacy lidocaine viscous ORAL Top 2% Sol 15 mL [INYO] 6953 CDM 00121-0903-40 NDC facility both 15 ML 15 15 Gross Charge Type: Pharmacy lidocaine viscous ORAL Top 2% Sol 15 mL [INYO] 6953 CDM 50383-0775-17 NDC facility both 15 ML 15 15 Gross Charge Type: Pharmacy lidocaine 5%-D7.5% Inj Sol 2 mL [INYO] 6954 CDM J2001 HCPCS 00409-4712-01 NDC facility both 2 EA 235 235 Gross Charge Type: Pharmacy RING PESSARY W/SUPPORT RING SZ 2 6957772 CDM facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price RING PESSARY W/SUPPORT RING SZ 2 6957772 CDM facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price zinc oxide Top 20% Oint [INYO] 6967 CDM 00536-1316-28 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 28.35 APP zinc oxide Top 20% Oint [INYO] 6967 CDM 00168-0062-31 NDC facility both 1 EA 16.15 16.15 Gross Charge Type: Pharmacy | NDC EA = 28.35 APP zinc oxide Top 20% Oint [INYO] 6967 CDM 00536-5700-28 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 28.35 APP allopurinol 300 mg Tab [INYO] 6970 CDM 51079-0206-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB allopurinol 300 mg Tab [INYO] 6970 CDM 00904-6572-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB allopurinol 300 mg Tab [INYO] 6970 CDM 62584-0713-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "RING PESSARY FOLDING # 4: 2-3/4""" 6973704 CDM facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price "RING PESSARY FOLDING # 4: 2-3/4""" 6973704 CDM facility both 197 197 Gross Charge Type: NIHD_Hosp_Profee_Price "RING PESSARY FOLDING # 5: 3""" 6973705 CDM facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price "RING PESSARY FOLDING # 5: 3""" 6973705 CDM facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foreign Body Localization Eye - Report 700301 CDM 982 RC 70030 HCPCS facility both 26 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foreign Body Localization Eye - Report 700301 CDM 982 RC 70030 HCPCS facility both 26 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foreign Body Localization Eye 700302 CDM 320 RC facility both TC 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foreign Body Localization Eye 700302 CDM 320 RC facility both TC 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price XR Mandible Less Than 4 Views - Report 701001 CDM 972 RC 70100 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Mandible Less Than 4 Views - Report 701001 CDM 972 RC 70100 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Mandible Less Than 4 Views 701002 CDM 320 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Mandible Less Than 4 Views 701002 CDM 320 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Mandible Complete 4+ Views - Report 701101 CDM 972 RC 70110 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR Mandible Complete 4+ Views - Report 701101 CDM 972 RC 70110 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR Mandible Complete 4+ Views 701102 CDM 320 RC facility both TC 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price XR Mandible Complete 4+ Views 701102 CDM 320 RC facility both TC 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facial Bones < 3 Views - Report 701401 CDM 972 RC 70140 HCPCS facility both 26 56 56 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facial Bones < 3 Views - Report 701401 CDM 972 RC 70140 HCPCS facility both 26 56 56 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facial Bones < 3 Views 701402 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facial Bones < 3 Views 701402 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facial Bones 3+ Views - Report 701501 CDM 972 RC 70150 HCPCS facility both 26 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facial Bones 3+ Views - Report 701501 CDM 972 RC 70150 HCPCS facility both 26 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facial Bones 3+ Views 701502 CDM 320 RC facility both TC 566 566 Gross Charge Type: NIHD_Hosp_Profee_Price XR Facial Bones 3+ Views 701502 CDM 320 RC facility both TC 566 566 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nasal Bones 3+ Views - Report 701601 CDM 972 RC 70160 HCPCS facility both 26 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nasal Bones 3+ Views - Report 701601 CDM 972 RC 70160 HCPCS facility both 26 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nasal Bones 3+ Views 701602 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nasal Bones 3+ Views 701602 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price acetic acid Top 0.25% Sol 1000 mL [INYO] 7017 CDM 00409-6143-09 NDC facility both 1000 ML 31.5 31.5 Gross Charge Type: Pharmacy XR Sinuses Paranasal < 3 Views - Report 702101 CDM 972 RC 70210 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sinuses Paranasal < 3 Views - Report 702101 CDM 972 RC 70210 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sinuses Paranasal < 3 Views 702102 CDM 320 RC facility both TC 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sinuses Paranasal < 3 Views 702102 CDM 320 RC facility both TC 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price charcoal 25 g Oral Susp 120 mL [INYO] 7022 CDM 66689-0202-04 NDC facility both 120 ML 148.45 148.45 Gross Charge Type: Pharmacy charcoal 25 g Oral Susp 120 mL [INYO] 7022 CDM 00574-0121-04 NDC facility both 120 ML 83.5 83.5 Gross Charge Type: Pharmacy XR Sinuses Paranasal Complete - Report 702201 CDM 972 RC 70220 HCPCS facility both 26 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sinuses Paranasal Complete - Report 702201 CDM 972 RC 70220 HCPCS facility both 26 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sinuses Paranasal Complete 702202 CDM 320 RC facility both TC 560 560 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sinuses Paranasal Complete 702202 CDM 320 RC facility both TC 560 560 Gross Charge Type: NIHD_Hosp_Profee_Price XR Skull < 4 Views - Report 702501 CDM 972 RC 70250 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Skull < 4 Views - Report 702501 CDM 972 RC 70250 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Skull < 4 Views 702502 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Skull < 4 Views 702502 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Skull Complete - Report 702601 CDM 972 RC 70260 HCPCS facility both 26 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price XR Skull Complete - Report 702601 CDM 972 RC 70260 HCPCS facility both 26 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price XR Skull Complete 702602 CDM 320 RC facility both TC 655 655 Gross Charge Type: NIHD_Hosp_Profee_Price XR Skull Complete 702602 CDM 320 RC facility both TC 655 655 Gross Charge Type: NIHD_Hosp_Profee_Price XR TMJ Open and Closed Bilateral - Report 703301 CDM 972 RC 70330 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR TMJ Open and Closed Bilateral - Report 703301 CDM 972 RC 70330 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR TMJ Open and Closed Bilateral 703302 CDM 320 RC facility both TC 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price XR TMJ Open and Closed Bilateral 703302 CDM 320 RC facility both TC 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price MRI TMJ 703361 CDM 610 RC facility both TC 3373 3373 Gross Charge Type: NIHD_Hosp_Profee_Price MRI TMJ 703361 CDM 610 RC facility both TC 3373 3373 Gross Charge Type: NIHD_Hosp_Profee_Price MRI TMJ - Report 703362 CDM 972 RC 70336 HCPCS facility both 26 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI TMJ - Report 703362 CDM 972 RC 70336 HCPCS facility both 26 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price XR Neck Soft Tissue - Report 703601 CDM 972 RC 70360 HCPCS facility both 26 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price XR Neck Soft Tissue - Report 703601 CDM 972 RC 70360 HCPCS facility both 26 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price XR Neck Soft Tissue 703602 CDM 320 RC facility both TC 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price XR Neck Soft Tissue 703602 CDM 320 RC facility both TC 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price spironolactone 25 mg Tab [INYO] 7045 CDM 00904-6927-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB spironolactone 25 mg Tab [INYO] 7045 CDM 63739-0544-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB CT Brain/Head w/o Contrast - Report 704501 CDM 972 RC 70450 HCPCS facility both 26 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/o Contrast - Report 704501 CDM 972 RC 70450 HCPCS facility both 26 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/o Contrast 704502 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/o Contrast 704502 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price 70450 CT Brain/Head w/o Contrast 704503 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price 70450 CT Brain/Head w/o Contrast 704503 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price 70450 CT Brain/Head w/o Contrast PROFEE 704504 CDM 972 RC 70450 HCPCS facility both 26 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price 70450 CT Brain/Head w/o Contrast PROFEE 704504 CDM 972 RC 70450 HCPCS facility both 26 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/ Contrast - Report 704601 CDM 972 RC 70460 HCPCS facility both 26 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/ Contrast - Report 704601 CDM 972 RC 70460 HCPCS facility both 26 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/ Contrast 704602 CDM 351 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/ Contrast 704602 CDM 351 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Head/Neck w/ Contrast 704603 CDM 350 RC facility both TC 1018 1018 Gross Charge Type: NIHD_Hosp_Profee_Price CT Head/Neck w/ Contrast 704603 CDM 350 RC facility both TC 1018 1018 Gross Charge Type: NIHD_Hosp_Profee_Price CT Head/Neck w/ Contrast - Report 704604 CDM 972 RC 70460 HCPCS facility both 26 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price CT Head/Neck w/ Contrast - Report 704604 CDM 972 RC 70460 HCPCS facility both 26 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/ + w/o Contrast - Report 704701 CDM 972 RC 70470 HCPCS facility both 26 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/ + w/o Contrast - Report 704701 CDM 972 RC 70470 HCPCS facility both 26 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/ + w/o Contrast 704702 CDM 351 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Brain/Head w/ + w/o Contrast 704702 CDM 351 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price 70470 CT Brain/Head w/ + w/o Contrast 704703 CDM 351 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price 70470 CT Brain/Head w/ + w/o Contrast 704703 CDM 351 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price 70470 CT Brain/Head w/ + w/o Contrast PROFEE 704704 CDM 972 RC 70470 HCPCS facility both 26 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price 70470 CT Brain/Head w/ + w/o Contrast PROFEE 704704 CDM 972 RC 70470 HCPCS facility both 26 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/o Contrast - Report 704801 CDM 972 RC 70480 HCPCS facility both 26 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/o Contrast - Report 704801 CDM 972 RC 70480 HCPCS facility both 26 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/o Contrast 704802 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/o Contrast 704802 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/ Contrast - Report 704811 CDM 972 RC 70481 HCPCS facility both 26 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/ Contrast - Report 704811 CDM 972 RC 70481 HCPCS facility both 26 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT IAC w/ + w/o Contrast 704812 CDM 351 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT IAC w/ + w/o Contrast 704812 CDM 351 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/ + w/o Contrast - Report 704821 CDM 972 RC 70482 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/ + w/o Contrast - Report 704821 CDM 972 RC 70482 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/ + w/o Contrast 704822 CDM 351 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Orbits Sella w/ + w/o Contrast 704822 CDM 351 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/o Contrast - Report 704861 CDM 972 RC 70486 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/o Contrast - Report 704861 CDM 972 RC 70486 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/o Contrast 704862 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/o Contrast 704862 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/o Contrast - Report 704863 CDM 972 RC 70486 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/o Contrast - Report 704863 CDM 972 RC 70486 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/o Contrast 704864 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/o Contrast 704864 CDM 351 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/ Contrast - Report 704871 CDM 972 RC 70487 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/ Contrast - Report 704871 CDM 972 RC 70487 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/ Contrast 704872 CDM 351 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/ Contrast 704872 CDM 351 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/ Contrast 704873 CDM 351 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/ Contrast 704873 CDM 351 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/ Contrast - Report 704874 CDM 972 RC 70487 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/ Contrast - Report 704874 CDM 972 RC 70487 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/ + w/o Contrast - Report 704881 CDM 972 RC 70488 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/ + w/o Contrast - Report 704881 CDM 972 RC 70488 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/ + w/o Contrast 704882 CDM 351 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price CT Maxillofacial w/ + w/o Contrast 704882 CDM 351 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/ +  w/o Contrast 704883 CDM 351 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/ +  w/o Contrast 704883 CDM 351 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/ + w/o Contrast - Report 704884 CDM 972 RC 70488 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price CT Sinus w/ + w/o Contrast - Report 704884 CDM 972 RC 70488 HCPCS facility both 26 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price ALPRAZolam 0.25 mg Tab [INYO] 7049 CDM 65862-0676-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ALPRAZolam 0.25 mg Tab [INYO] 7049 CDM 00904-5858-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ALPRAZolam 0.25 mg Tab [INYO] 7049 CDM 67253-0900-10 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ALPRAZolam 0.25 mg Tab [INYO] 7049 CDM 63739-0644-10 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB CT Neck Soft Tissue w/o Contrast - Report 704901 CDM 972 RC 70490 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/o Contrast - Report 704901 CDM 972 RC 70490 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/o Contrast 704902 CDM 350 RC facility both TC 2514 2514 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/o Contrast 704902 CDM 350 RC facility both TC 2514 2514 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/ Contrast - Report 704911 CDM 972 RC 70491 HCPCS facility both 26 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/ Contrast - Report 704911 CDM 972 RC 70491 HCPCS facility both 26 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/ Contrast 704912 CDM 350 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/ Contrast 704912 CDM 350 RC facility both TC 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/ + w/o Contrast - Report 704921 CDM 972 RC 70492 HCPCS facility both 26 379 379 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/ + w/o Contrast - Report 704921 CDM 972 RC 70492 HCPCS facility both 26 379 379 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/ + w/o Contrast 704922 CDM 350 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Neck Soft Tissue w/ + w/o Contrast 704922 CDM 350 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Brain/Head - Report 704961 CDM 972 RC 70496 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Brain/Head - Report 704961 CDM 972 RC 70496 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Brain/Head 704962 CDM 351 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Brain/Head 704962 CDM 351 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Brain/ Head 704963 CDM 351 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Brain/ Head 704963 CDM 351 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Head/Neck - Report 704964 CDM 972 RC 70496 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Head/Neck - Report 704964 CDM 972 RC 70496 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Neck - Report 704981 CDM 972 RC 70498 HCPCS facility both 26 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Neck - Report 704981 CDM 972 RC 70498 HCPCS facility both 26 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Neck 704982 CDM 350 RC facility both TC 3708 3708 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Neck 704982 CDM 350 RC facility both TC 3708 3708 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/o Contrast - Report 705401 CDM 972 RC 70540 HCPCS facility both 26 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/o Contrast - Report 705401 CDM 972 RC 70540 HCPCS facility both 26 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/o Contrast 705402 CDM 610 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/o Contrast 705402 CDM 610 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/o Contrast 705403 CDM 610 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/o Contrast 705403 CDM 610 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/o Contrast - Report 705404 CDM 972 RC 70540 HCPCS facility both 26 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/o Contrast - Report 705404 CDM 972 RC 70540 HCPCS facility both 26 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/ Contrast 705422 CDM 610 RC facility both TC 3687 3687 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/ Contrast 705422 CDM 610 RC facility both TC 3687 3687 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/ Contrast 705423 CDM 610 RC facility both TC 3687 3687 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/ Contrast 705423 CDM 610 RC facility both TC 3687 3687 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/ + w/o Contrast - Report 705431 CDM 972 RC 70543 HCPCS facility both 26 1033 1033 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/ + w/o Contrast - Report 705431 CDM 972 RC 70543 HCPCS facility both 26 1033 1033 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/ + w/o Contrast 705432 CDM 610 RC facility both TC 4588 4588 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Face Neck Orbit w/ + w/o Contrast 705432 CDM 610 RC facility both TC 4588 4588 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/ +w/o Contrast 705433 CDM 610 RC facility both TC 4588 4588 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/ +w/o Contrast 705433 CDM 610 RC facility both TC 4588 4588 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/ +w/o Contrast - Report 705434 CDM 972 RC 70543 HCPCS facility both 26 1033 1033 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Neck w/ +w/o Contrast - Report 705434 CDM 972 RC 70543 HCPCS facility both 26 1033 1033 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/o Contrast - Report 705441 CDM 972 RC 70544 HCPCS facility both 26 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/o Contrast - Report 705441 CDM 972 RC 70544 HCPCS facility both 26 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/o Contrast 705442 CDM 615 RC facility both TC 3122 3122 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/o Contrast 705442 CDM 615 RC facility both TC 3122 3122 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/ Contrast - Report 705451 CDM 972 RC 70545 HCPCS facility both 26 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/ Contrast - Report 705451 CDM 972 RC 70545 HCPCS facility both 26 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/ Contrast 705452 CDM 615 RC facility both TC 3446 3446 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/ Contrast 705452 CDM 615 RC facility both TC 3446 3446 Gross Charge Type: NIHD_Hosp_Profee_Price MRV Brain w/ + w/o Contrast 70546_615 CDM 615 RC facility both TC 4400 4400 Gross Charge Type: NIHD_Hosp_Profee_Price MRV Brain w/ + w/o Contrast 70546_615 CDM 615 RC facility both TC 4400 4400 Gross Charge Type: NIHD_Hosp_Profee_Price MRV Brain w/ + w/o Contrast - Report 70546_972 CDM 972 RC 70546 HCPCS facility both 26 1292 1292 Gross Charge Type: NIHD_Hosp_Profee_Price MRV Brain w/ + w/o Contrast - Report 70546_972 CDM 972 RC 70546 HCPCS facility both 26 1292 1292 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/ + w/o Contrast - Report 705461 CDM 972 RC 70546 HCPCS facility both 26 1292 1292 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/ + w/o Contrast - Report 705461 CDM 972 RC 70546 HCPCS facility both 26 1292 1292 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/ + w/o Contrast 705462 CDM 615 RC facility both TC 4400 4400 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Brain/Head w/ + w/o Contrast 705462 CDM 615 RC facility both TC 4400 4400 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/o Contrast - Report 705471 CDM 972 RC 70547 HCPCS facility both 26 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/o Contrast - Report 705471 CDM 972 RC 70547 HCPCS facility both 26 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/o Contrast 705472 CDM 615 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/o Contrast 705472 CDM 615 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/ Contrast - Report 705481 CDM 972 RC 70548 HCPCS facility both 26 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/ Contrast - Report 705481 CDM 972 RC 70548 HCPCS facility both 26 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/ Contrast 705482 CDM 615 RC facility both TC 3415 3415 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/ Contrast 705482 CDM 615 RC facility both TC 3415 3415 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/ + w/o Contrast - Report 705491 CDM 972 RC 70549 HCPCS facility both 26 1260 1260 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/ + w/o Contrast - Report 705491 CDM 972 RC 70549 HCPCS facility both 26 1260 1260 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/ + w/o Contrast 705492 CDM 615 RC facility both TC 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Neck w/ + w/o Contrast 705492 CDM 615 RC facility both TC 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/o Contrast - Report 705511 CDM 972 RC 70551 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/o Contrast - Report 705511 CDM 972 RC 70551 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/o Contrast 705512 CDM 611 RC facility both TC 3467 3467 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/o Contrast 705512 CDM 611 RC facility both TC 3467 3467 Gross Charge Type: NIHD_Hosp_Profee_Price MRI IAC w/o Contrast 705513 CDM 610 RC facility both TC 3467 3467 Gross Charge Type: NIHD_Hosp_Profee_Price MRI IAC w/o Contrast 705513 CDM 610 RC facility both TC 3467 3467 Gross Charge Type: NIHD_Hosp_Profee_Price MRI IAC w/o Contrast - Report 705514 CDM 972 RC 70551 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI IAC w/o Contrast - Report 705514 CDM 972 RC 70551 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/o Contrast 705515 CDM 610 RC facility both TC 3467 3467 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/o Contrast 705515 CDM 610 RC facility both TC 3467 3467 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/o Contrast - Report 705516 CDM 972 RC 70551 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/o Contrast - Report 705516 CDM 972 RC 70551 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/ Contrast - Report 705521 CDM 972 RC 70552 HCPCS facility both 26 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/ Contrast - Report 705521 CDM 972 RC 70552 HCPCS facility both 26 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/ Contrast 705522 CDM 611 RC facility both TC 3876 3876 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/ Contrast 705522 CDM 611 RC facility both TC 3876 3876 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/ Contrast 705523 CDM 610 RC facility both TC 3876 3876 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/ Contrast 705523 CDM 610 RC facility both TC 3876 3876 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/ Contrast - Report 705524 CDM 972 RC 70552 HCPCS facility both 26 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/ Contrast - Report 705524 CDM 972 RC 70552 HCPCS facility both 26 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/ + w/o Contrast - Report 705531 CDM 972 RC 70553 HCPCS facility both 26 816 816 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/ + w/o Contrast - Report 705531 CDM 972 RC 70553 HCPCS facility both 26 816 816 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/ + w/o Contrast 705532 CDM 611 RC facility both TC 4892 4892 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Brain w/ + w/o Contrast 705532 CDM 611 RC facility both TC 4892 4892 Gross Charge Type: NIHD_Hosp_Profee_Price MRI IAC w/ + w/o Contrast 705533 CDM 610 RC facility both TC 4892 4892 Gross Charge Type: NIHD_Hosp_Profee_Price MRI IAC w/ + w/o Contrast 705533 CDM 610 RC facility both TC 4892 4892 Gross Charge Type: NIHD_Hosp_Profee_Price MRI IAC w/ + w/o Contrast - Report 705534 CDM 972 RC 70553 HCPCS facility both 26 816 816 Gross Charge Type: NIHD_Hosp_Profee_Price MRI IAC w/ + w/o Contrast - Report 705534 CDM 972 RC 70553 HCPCS facility both 26 816 816 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/ + w/o Contrast 705535 CDM 610 RC facility both TC 4892 4892 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/ + w/o Contrast 705535 CDM 610 RC facility both TC 4892 4892 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/ + w/o Contrast - Report 705536 CDM 972 RC 70553 HCPCS facility both 26 816 816 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pituitary w/ + w/o Contrast - Report 705536 CDM 972 RC 70553 HCPCS facility both 26 816 816 Gross Charge Type: NIHD_Hosp_Profee_Price trihexyphenidyl 2 mg Tab [INYO] 7094 CDM 00591-5335-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB trihexyphenidyl 2 mg Tab [INYO] 7094 CDM 16571-0160-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB adenosine 6 mg/2mL IV Sol [INYO] 7099 CDM J0153 HCPCS 67457-0855-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy SAFE-T-CENTESIS PLUS 8 FR CATHETER DRAIN 7101280 CDM 272 RC facility both 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price SAFE-T-CENTESIS PLUS 8 FR CATHETER DRAIN 7101280 CDM 272 RC facility both 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 1 View 710451 CDM 324 RC facility both TC 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 1 View 710451 CDM 324 RC facility both TC 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 1 View - Report 710452 CDM 972 RC 71045 HCPCS facility both 26 41 41 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 1 View - Report 710452 CDM 972 RC 71045 HCPCS facility both 26 41 41 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 1 View Discount - Report 710454 CDM 972 RC 71045 HCPCS facility both 26 41 41 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 1 View Discount - Report 710454 CDM 972 RC 71045 HCPCS facility both 26 41 41 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views - Report 710461 CDM 972 RC 71046 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views - Report 710461 CDM 972 RC 71046 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views 710463 CDM 324 RC facility both TC 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views 710463 CDM 324 RC facility both TC 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Fluoroscopy - Report 710465 CDM 972 RC 71046 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Fluoroscopy - Report 710465 CDM 972 RC 71046 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Apical Lordotic - Report 710471 CDM 972 RC 71047 HCPCS facility both 26 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Apical Lordotic - Report 710471 CDM 972 RC 71047 HCPCS facility both 26 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Apical Lordotic 710472 CDM 324 RC facility both TC 461 461 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Apical Lordotic 710472 CDM 324 RC facility both TC 461 461 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Obliques - Report 710481 CDM 972 RC 71048 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Obliques - Report 710481 CDM 972 RC 71048 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Obliques 710482 CDM 324 RC facility both TC 508 508 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 2 Views w/ Obliques 710482 CDM 324 RC facility both TC 508 508 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 4+ Views - Report 710483 CDM 982 RC 71048 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 4+ Views - Report 710483 CDM 982 RC 71048 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 4+ Views 710484 CDM 324 RC facility both TC 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 4+ Views 710484 CDM 324 RC facility both TC 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest Decubitus - Report 710485 CDM 972 RC 71048 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest Decubitus - Report 710485 CDM 972 RC 71048 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest Decubitus 710486 CDM 324 RC facility both TC 532 532 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest Decubitus 710486 CDM 324 RC facility both TC 532 532 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 4+ Views w/ Fluoroscopy - Report 710487 CDM 972 RC 71048 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Chest 4+ Views w/ Fluoroscopy - Report 710487 CDM 972 RC 71048 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 2 Views Right - Report 711001 CDM 972 RC 71100 HCPCS facility both 26RT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 2 Views Right - Report 711001 CDM 972 RC 71100 HCPCS facility both 26RT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 2 Views Left - Report 711002 CDM 972 RC 71100 HCPCS facility both 26LT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 2 Views Left - Report 711002 CDM 972 RC 71100 HCPCS facility both 26LT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 2 Views Left 711003 CDM 320 RC facility both TCLT 445 445 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 2 Views Left 711003 CDM 320 RC facility both TCLT 445 445 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 2 Views Right 711004 CDM 320 RC facility both TCRT 445 445 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 2 Views Right 711004 CDM 320 RC facility both TCRT 445 445 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Right - Report 711011 CDM 972 RC 71101 HCPCS facility both 26RT 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Right - Report 711011 CDM 972 RC 71101 HCPCS facility both 26RT 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Left - Report 711012 CDM 972 RC 71101 HCPCS facility both 26LT 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Left - Report 711012 CDM 972 RC 71101 HCPCS facility both 26LT 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Left 711013 CDM 320 RC facility both TCLT 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Left 711013 CDM 320 RC facility both TCLT 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Right 711014 CDM 320 RC facility both TCRT 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Right 711014 CDM 320 RC facility both TCRT 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 71101 XR Ribs w/ PA Chest Left 711015 CDM 320 RC facility both TC 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 71101 XR Ribs w/ PA Chest Left 711015 CDM 320 RC facility both TC 550 550 Gross Charge Type: NIHD_Hosp_Profee_Price 71101 XR Ribs w/ PA Chest Left PROFEE 711016 CDM 972 RC 71101 HCPCS facility both 26 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 71101 XR Ribs w/ PA Chest Left PROFEE 711016 CDM 972 RC 71101 HCPCS facility both 26 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 3 Views Bilateral - Report 711101 CDM 972 RC 71110 HCPCS facility both 2650 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 3 Views Bilateral - Report 711101 CDM 972 RC 71110 HCPCS facility both 2650 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 3 Views Bilateral 711102 CDM 320 RC facility both TC 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs 3 Views Bilateral 711102 CDM 320 RC facility both TC 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Bilateral - Report 711111 CDM 972 RC 71111 HCPCS facility both 2650 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Bilateral - Report 711111 CDM 972 RC 71111 HCPCS facility both 2650 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Bilateral 711112 CDM 320 RC facility both TC 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ribs w/ PA Chest Bilateral 711112 CDM 320 RC facility both TC 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sternum 2+ Views - Report 711201 CDM 972 RC 71120 HCPCS facility both 26 59 59 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sternum 2+ Views - Report 711201 CDM 972 RC 71120 HCPCS facility both 26 59 59 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sternum 2+ Views 711202 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sternum 2+ Views 711202 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sternoclavicular Joint(s) - Report 711301 CDM 972 RC 71130 HCPCS facility both 26 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sternoclavicular Joint(s) - Report 711301 CDM 972 RC 71130 HCPCS facility both 26 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sternoclavicular Joint(s) 711302 CDM 320 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sternoclavicular Joint(s) 711302 CDM 320 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price povidone iodine Top 10% Oint [INYO] 7117 CDM 00536-1271-80 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 28.35 APP povidone iodine Top 10% Oint [INYO] 7117 CDM 00904-1102-31 NDC facility both 1 EA 15.6 15.6 Gross Charge Type: Pharmacy | NDC EA = 28.35 APP CT Chest High Resolution 712501 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest High Resolution 712501 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest High Resolution - Report 712502 CDM 972 RC 71250 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest High Resolution - Report 712502 CDM 972 RC 71250 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/o Contrast - Report 712503 CDM 972 RC 71250 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/o Contrast - Report 712503 CDM 972 RC 71250 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/o Contrast 712504 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/o Contrast 712504 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/o Contrast 712505 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/o Contrast 712505 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/o Contrast - Report 712506 CDM 972 RC 71250 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/o Contrast - Report 712506 CDM 972 RC 71250 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/o Contrast 712507 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/o Contrast 712507 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/o Contrast - Report 712508 CDM 972 RC 71250 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/o Contrast - Report 712508 CDM 972 RC 71250 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/ Contrast - Report 712601 CDM 972 RC 71260 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/ Contrast - Report 712601 CDM 972 RC 71260 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/ Contrast 712602 CDM 352 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/ Contrast 712602 CDM 352 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/ Contrast 712603 CDM 352 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/ Contrast 712603 CDM 352 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/ Contrast - Report 712604 CDM 972 RC 71260 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/ Contrast - Report 712604 CDM 972 RC 71260 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/ Contrast 712605 CDM 352 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/ Contrast 712605 CDM 352 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/ Contrast - Report 712606 CDM 972 RC 71260 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/ Contrast - Report 712606 CDM 972 RC 71260 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/ + w/o Contrast - Report 712701 CDM 972 RC 71270 HCPCS facility both 26 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/ + w/o Contrast - Report 712701 CDM 972 RC 71270 HCPCS facility both 26 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/ + w/o Contrast 712702 CDM 352 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest w/ + w/o Contrast 712702 CDM 352 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/ + w/o Contrast 712703 CDM 352 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/ + w/o Contrast 712703 CDM 352 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/ + w/o Contrast - Report 712704 CDM 972 RC 71270 HCPCS facility both 26 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abdomen w/ + w/o Contrast - Report 712704 CDM 972 RC 71270 HCPCS facility both 26 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/ + w/o Contrast 712705 CDM 352 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/ + w/o Contrast 712705 CDM 352 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/ + w/o Contrast - Report 712706 CDM 972 RC 71270 HCPCS facility both 26 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price CT Chest/Abd/Pelvis w/ + w/o Contrast - Report 712706 CDM 972 RC 71270 HCPCS facility both 26 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price 71271 CT Low Dose Lung Screening 71271 CDM 350 RC facility both TC 1337 1337 Gross Charge Type: NIHD_Hosp_Profee_Price 71271 CT Low Dose Lung Screening 71271 CDM 350 RC facility both TC 1337 1337 Gross Charge Type: NIHD_Hosp_Profee_Price 71271 CT Low Dose Lung Screening PROFEE 712711 CDM 972 RC 71271 HCPCS facility both 26 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price 71271 CT Low Dose Lung Screening PROFEE 712711 CDM 972 RC 71271 HCPCS facility both 26 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price CT Low Dose Lung Screening - Report 712713 CDM 972 RC 71271 HCPCS facility both 26 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price CT Low Dose Lung Screening - Report 712713 CDM 972 RC 71271 HCPCS facility both 26 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price CT Low Dose Lung Screening 712714 CDM 352 RC facility both TC 1337 1337 Gross Charge Type: NIHD_Hosp_Profee_Price CT Low Dose Lung Screening 712714 CDM 352 RC facility both TC 1337 1337 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lung Cancer Screening 712715 CDM 352 RC facility both TC 1337 1337 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lung Cancer Screening 712715 CDM 352 RC facility both TC 1337 1337 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lung Cancer Screening - Report 712716 CDM 972 RC 71271 HCPCS facility both 26 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lung Cancer Screening - Report 712716 CDM 972 RC 71271 HCPCS facility both 26 226 226 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Chest - Report 712751 CDM 972 RC 71275 HCPCS facility both 26 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Chest - Report 712751 CDM 972 RC 71275 HCPCS facility both 26 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Chest 712752 CDM 352 RC facility both TC 3719 3719 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Chest 712752 CDM 352 RC facility both TC 3719 3719 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Chest/Abdomen/Pelvis 712753 CDM 352 RC facility both TC 3719 3719 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Chest/Abdomen/Pelvis 712753 CDM 352 RC facility both TC 3719 3719 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Chest/Abdomen/Pelvis - Report 712754 CDM 972 RC 71275 HCPCS facility both 26 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Chest/Abdomen/Pelvis - Report 712754 CDM 972 RC 71275 HCPCS facility both 26 757 757 Gross Charge Type: NIHD_Hosp_Profee_Price cloNIDine 0.1 mg Tab [INYO] 7129 CDM 60687-0113-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cloNIDine 0.1 mg Tab [INYO] 7129 CDM 00904-5656-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB MRI Chest w/o Contrast - Report 715501 CDM 972 RC 71550 HCPCS facility both 26 734 734 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/o Contrast - Report 715501 CDM 972 RC 71550 HCPCS facility both 26 734 734 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/o Contrast 715502 CDM 610 RC facility both TC 2871 2871 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/o Contrast 715502 CDM 610 RC facility both TC 2871 2871 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/ Contrast - Report 715511 CDM 972 RC 71551 HCPCS facility both 26 622 622 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/ Contrast - Report 715511 CDM 972 RC 71551 HCPCS facility both 26 622 622 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/ Contrast 715512 CDM 610 RC facility both TC 3034 3034 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/ Contrast 715512 CDM 610 RC facility both TC 3034 3034 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/ + w/o Contrast - Report 715521 CDM 972 RC 71552 HCPCS facility both 26 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/ + w/o Contrast - Report 715521 CDM 972 RC 71552 HCPCS facility both 26 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/ + w/o Contrast 715522 CDM 610 RC facility both TC 4714 4714 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Chest w/ + w/o Contrast 715522 CDM 610 RC facility both TC 4714 4714 Gross Charge Type: NIHD_Hosp_Profee_Price cephalexin 250 mg/5 mL Oral Liq 200mL [INYO] 7189 CDM 67877-0545-68 NDC facility both 200 ML 202.5 202.5 Gross Charge Type: Pharmacy cephalexin 250 mg/5 mL Oral Liq 200mL [INYO] 7189 CDM 00093-4177-74 NDC facility both 200 ML 260 260 Gross Charge Type: Pharmacy lisinopril 5 mg Tab [INYO] 7200 CDM 00904-6797-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lisinopril 5 mg Tab [INYO] 7200 CDM 00904-5811-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB furosemide 20 mg Tab [INYO] 7202 CDM 00904-7177-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB furosemide 20 mg Tab [INYO] 7202 CDM 51079-0072-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB XR Spine Cervical 1 View - Report 720201 CDM 72020 HCPCS facility both 26 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 1 View - Report 720201 CDM 72020 HCPCS facility both 26 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 1 View 720202 CDM 320 RC facility both TC 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 1 View 720202 CDM 320 RC facility both TC 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 2 or 3 Views - Report 720401 CDM 972 RC 72040 HCPCS facility both 26 62 62 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 2 or 3 Views - Report 720401 CDM 972 RC 72040 HCPCS facility both 26 62 62 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 2 or 3 Views 720402 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 2 or 3 Views 720402 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 4 or 5 Views - Report 720501 CDM 972 RC 72050 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 4 or 5 Views - Report 720501 CDM 972 RC 72050 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 4 or 5 Views 720502 CDM 320 RC facility both TC 670 670 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical 4 or 5 Views 720502 CDM 320 RC facility both TC 670 670 Gross Charge Type: NIHD_Hosp_Profee_Price 72052 XR Spine Cervical 6+ Views PROFEE 72052 CDM 972 RC 72052 HCPCS facility both 26 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price 72052 XR Spine Cervical 6+ Views PROFEE 72052 CDM 972 RC 72052 HCPCS facility both 26 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical Flexion + Extension 720521 CDM 320 RC facility both TC 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical Flexion + Extension 720521 CDM 320 RC facility both TC 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical Flexion + Extension - Report 720522 CDM 972 RC 72052 HCPCS facility both 26 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Cervical Flexion + Extension - Report 720522 CDM 972 RC 72052 HCPCS facility both 26 101 101 Gross Charge Type: NIHD_Hosp_Profee_Price ibuprofen 400 mg Tab [INYO] 7207 CDM 00904-5853-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ibuprofen 400 mg Tab 7207 CDM 60687-0446-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ibuprofen 400 mg Tab [INYO] 7207 CDM 67877-0319-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB XR Spine Thoracic 2 Views - Report 720701 CDM 972 RC 72070 HCPCS facility both 26 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracic 2 Views - Report 720701 CDM 972 RC 72070 HCPCS facility both 26 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracic 2 Views 720702 CDM 320 RC facility both TC 456 456 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracic 2 Views 720702 CDM 320 RC facility both TC 456 456 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracic 3 Views - Report 720721 CDM 972 RC 72072 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracic 3 Views - Report 720721 CDM 972 RC 72072 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracic 3 Views 720722 CDM 320 RC facility both TC 545 545 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracic 3 Views 720722 CDM 320 RC facility both TC 545 545 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracolumbar 2+ Views - Report 720801 CDM 972 RC 72080 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracolumbar 2+ Views - Report 720801 CDM 972 RC 72080 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracolumbar 2+ Views 720802 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Thoracolumbar 2+ Views 720802 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Scoliosis 2-3 Views 720821 CDM 320 RC facility both TC 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Scoliosis 2-3 Views 720821 CDM 320 RC facility both TC 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Scoliosis 6+ Views 720822 CDM 320 RC facility both TC 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Scoliosis 6+ Views 720822 CDM 320 RC facility both TC 555 555 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Scoliosis 2-3 Views - Report 720824 CDM 972 RC 72082 HCPCS facility both 26 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Scoliosis 2-3 Views - Report 720824 CDM 972 RC 72082 HCPCS facility both 26 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price 72083 XR Spine Scoliosis 4-5 View TECH 720831 CDM 320 RC facility both TC 665 665 Gross Charge Type: NIHD_Hosp_Profee_Price 72083 XR Spine Scoliosis 4-5 View TECH 720831 CDM 320 RC facility both TC 665 665 Gross Charge Type: NIHD_Hosp_Profee_Price 72083 XR Spine Scoliosis 4-5 View PROFEE 720832 CDM 972 RC 72083 HCPCS facility both 26 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 72083 XR Spine Scoliosis 4-5 View PROFEE 720832 CDM 972 RC 72083 HCPCS facility both 26 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral 2 or 3 Views - Report 721001 CDM 972 RC 72100 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral 2 or 3 Views - Report 721001 CDM 972 RC 72100 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral 2 or 3 Views 721002 CDM 320 RC facility both TC 503 503 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral 2 or 3 Views 721002 CDM 320 RC facility both TC 503 503 Gross Charge Type: NIHD_Hosp_Profee_Price simethicone 40 mg/0.6 mL Oral Liq [INYO] 7211 CDM 00536-1303-75 NDC facility both 30 ML 13.38 13.38 Gross Charge Type: Pharmacy simethicone 40 mg/0.6 mL Oral Liq [INYO] 7211 CDM 00904-5894-30 NDC facility both 30 ML 21 21 Gross Charge Type: Pharmacy simethicone 40 mg/0.6 mL Oral Liq [INYO] 7211 CDM 00536-2220-75 NDC facility both 30 ML 42.3 42.3 Gross Charge Type: Pharmacy XR Spine Lumbar Flexion + Extension 72110_320 CDM 320 RC facility both TC 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbar Flexion + Extension 72110_320 CDM 320 RC facility both TC 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbar Flexion + Extension - Report 72110_972 CDM 972 RC 72110 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbar Flexion + Extension - Report 72110_972 CDM 972 RC 72110 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral 4+ Views - Report 721101 CDM 972 RC 72110 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral 4+ Views - Report 721101 CDM 972 RC 72110 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral 4+ Views 721102 CDM 320 RC facility both TC 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral 4+ Views 721102 CDM 320 RC facility both TC 681 681 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral w/ Bending 6+ Views - Report 721141 CDM 972 RC 72114 HCPCS facility both 26 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral w/ Bending 6+ Views - Report 721141 CDM 972 RC 72114 HCPCS facility both 26 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral w/ Bending 6+ Views 721142 CDM 320 RC facility both TC 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral w/ Bending 6+ Views 721142 CDM 320 RC facility both TC 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price simethicone 80 mg Chew Tab [INYO] 7212 CDM 77333-0812-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB simethicone 80 mg Chew Tab [INYO] 7212 CDM 63739-0225-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB simethicone 80 mg Chew Tab [INYO] 7212 CDM 00904-7206-60 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB simethicone 80 mg Chew Tab [INYO] 7212 CDM 00904-5068-60 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB XR Spine Lumbosacral Bending 2-3 Views 72120 CDM 320 RC facility both 643 643 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral Bending 2-3 Views 72120 CDM 320 RC facility both 643 643 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral Bending 2-3 Views - Report 721201 CDM 972 RC 72120 HCPCS facility both 26 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price XR Spine Lumbosacral Bending 2-3 Views - Report 721201 CDM 972 RC 72120 HCPCS facility both 26 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/o Contrast - Report 721251 CDM 972 RC 72125 HCPCS facility both 26 397 397 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/o Contrast - Report 721251 CDM 972 RC 72125 HCPCS facility both 26 397 397 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/o Contrast 721252 CDM 350 RC facility both TC 2923 2923 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/o Contrast 721252 CDM 350 RC facility both TC 2923 2923 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/ Contrast - Report 721261 CDM 972 RC 72126 HCPCS facility both 26 486 486 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/ Contrast - Report 721261 CDM 972 RC 72126 HCPCS facility both 26 486 486 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/ Contrast 721262 CDM 350 RC facility both TC 3038 3038 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/ Contrast 721262 CDM 350 RC facility both TC 3038 3038 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/ + w/o Contrast - Report 721271 CDM 72127 HCPCS facility both 26 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/ + w/o Contrast - Report 721271 CDM 72127 HCPCS facility both 26 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/ + w/o Contrast 721272 CDM 350 RC facility both TC 3337 3337 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Cervical w/ + w/o Contrast 721272 CDM 350 RC facility both TC 3337 3337 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/o Contrast - Report 721281 CDM 972 RC 72128 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/o Contrast - Report 721281 CDM 972 RC 72128 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/o Contrast 721282 CDM 350 RC facility both TC 2923 2923 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/o Contrast 721282 CDM 350 RC facility both TC 2923 2923 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/ Contrast - Report 721291 CDM 972 RC 72129 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/ Contrast - Report 721291 CDM 972 RC 72129 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/ Contrast 721292 CDM 350 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/ Contrast 721292 CDM 350 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/ + w/o Contrast - Report 721301 CDM 972 RC 72130 HCPCS facility both 26 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/ + w/o Contrast - Report 721301 CDM 972 RC 72130 HCPCS facility both 26 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/ + w/o Contrast 721302 CDM 350 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Thoracic w/ + w/o Contrast 721302 CDM 350 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/o Contrast - Report 721311 CDM 972 RC 72131 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/o Contrast - Report 721311 CDM 972 RC 72131 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/o Contrast 721312 CDM 350 RC facility both TC 2923 2923 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/o Contrast 721312 CDM 350 RC facility both TC 2923 2923 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/ Contrast - Report 721321 CDM 972 RC 72132 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/ Contrast - Report 721321 CDM 972 RC 72132 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/ Contrast 721322 CDM 350 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/ Contrast 721322 CDM 350 RC facility both TC 3184 3184 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/ + w/o Contrast - Report 721331 CDM 972 RC 72133 HCPCS facility both 26 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/ + w/o Contrast - Report 721331 CDM 972 RC 72133 HCPCS facility both 26 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/ + w/o Contrast 721332 CDM 350 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price CT Spine Lumbar w/ + w/o Contrast 721332 CDM 350 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/o Contrast - Report 721411 CDM 972 RC 72141 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/o Contrast - Report 721411 CDM 972 RC 72141 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/o Contrast 721412 CDM 612 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/o Contrast 721412 CDM 612 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/ Contrast 721422 CDM 610 RC facility both TC 3598 3598 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/ Contrast 721422 CDM 610 RC facility both TC 3598 3598 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/o Contrast - Report 721461 CDM 972 RC 72146 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/o Contrast - Report 721461 CDM 972 RC 72146 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/o Contrast 721462 CDM 612 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/o Contrast 721462 CDM 612 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/ Contrast 721472 CDM 610 RC facility both TC 3750 3750 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/ Contrast 721472 CDM 610 RC facility both TC 3750 3750 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/o Contrast - Report 721481 CDM 972 RC 72148 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/o Contrast - Report 721481 CDM 972 RC 72148 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/o Contrast 721482 CDM 612 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/o Contrast 721482 CDM 612 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/ Contrast 721492 CDM 610 RC facility both TC 3663 3663 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/ Contrast 721492 CDM 610 RC facility both TC 3663 3663 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/ + w/o Contrast - Report 721561 CDM 972 RC 72156 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/ + w/o Contrast - Report 721561 CDM 972 RC 72156 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/ + w/o Contrast 721562 CDM 612 RC facility both TC 4934 4934 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Cervical w/ + w/o Contrast 721562 CDM 612 RC facility both TC 4934 4934 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/ + w/o Contrast - Report 721571 CDM 972 RC 72157 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/ + w/o Contrast - Report 721571 CDM 972 RC 72157 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/ + w/o Contrast 721572 CDM 612 RC facility both TC 4934 4934 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Thoracic w/ + w/o Contrast 721572 CDM 612 RC facility both TC 4934 4934 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/ + w/o Contrast - Report 721581 CDM 972 RC 72158 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/ + w/o Contrast - Report 721581 CDM 972 RC 72158 HCPCS facility both 26 804 804 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/ + w/o Contrast 721582 CDM 612 RC facility both TC 4960 4960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Spine Lumbar w/ + w/o Contrast 721582 CDM 612 RC facility both TC 4960 4960 Gross Charge Type: NIHD_Hosp_Profee_Price XR Pelvis 1 or 2 Views - Report 721701 CDM 972 RC 72170 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Pelvis 1 or 2 Views - Report 721701 CDM 972 RC 72170 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Pelvis 1 or 2 Views 721702 CDM 320 RC facility both TC 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price XR Pelvis 1 or 2 Views 721702 CDM 320 RC facility both TC 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price XR Pelvis Complete 3+ Views - Report 721901 CDM 972 RC 72190 HCPCS facility both 26 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price XR Pelvis Complete 3+ Views - Report 721901 CDM 972 RC 72190 HCPCS facility both 26 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price XR Pelvis Complete 3+ Views 721902 CDM 320 RC facility both TC 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price XR Pelvis Complete 3+ Views 721902 CDM 320 RC facility both TC 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen and Pelvis - Report 721911 CDM 972 RC 72191 HCPCS facility both 26 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen and Pelvis - Report 721911 CDM 972 RC 72191 HCPCS facility both 26 1008 1008 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen and Pelvis 721912 CDM 352 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen and Pelvis 721912 CDM 352 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/o Contrast - Report 721921 CDM 972 RC 72192 HCPCS facility both 26 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/o Contrast - Report 721921 CDM 972 RC 72192 HCPCS facility both 26 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/o Contrast 721922 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/o Contrast 721922 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/ Contrast - Report 721931 CDM 972 RC 72193 HCPCS facility both 26 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/ Contrast - Report 721931 CDM 972 RC 72193 HCPCS facility both 26 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/ Contrast 721932 CDM 352 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/ Contrast 721932 CDM 352 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/ + w/o Contrast - Report 721941 CDM 972 RC 72194 HCPCS facility both 26 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/ + w/o Contrast - Report 721941 CDM 972 RC 72194 HCPCS facility both 26 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/ + w/o Contrast 721942 CDM 352 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price CT Pelvis w/ + w/o Contrast 721942 CDM 352 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/o Contrast - Report 721951 CDM 972 RC 72195 HCPCS facility both 26 768 768 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/o Contrast - Report 721951 CDM 972 RC 72195 HCPCS facility both 26 768 768 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/o Contrast 721952 CDM 610 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/o Contrast 721952 CDM 610 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/o Contrast 721953 CDM 610 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/o Contrast 721953 CDM 610 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/o Contrast - Report 721954 CDM 972 RC 72195 HCPCS facility both 26 768 768 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/o Contrast - Report 721954 CDM 972 RC 72195 HCPCS facility both 26 768 768 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/ Contrast - Report 721961 CDM 972 RC 72196 HCPCS facility both 26 1084 1084 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/ Contrast - Report 721961 CDM 972 RC 72196 HCPCS facility both 26 1084 1084 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/ Contrast 721962 CDM 610 RC facility both TC 3785 3785 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/ Contrast 721962 CDM 610 RC facility both TC 3785 3785 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/ Contrast 721963 CDM 610 RC facility both TC 3785 3785 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/ Contrast 721963 CDM 610 RC facility both TC 3785 3785 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/ Contrast - Report 721964 CDM 972 RC 72196 HCPCS facility both 26 1084 1084 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/ Contrast - Report 721964 CDM 972 RC 72196 HCPCS facility both 26 1084 1084 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/ + w/o Contrast - Report 721971 CDM 972 RC 72197 HCPCS facility both 26 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/ + w/o Contrast - Report 721971 CDM 972 RC 72197 HCPCS facility both 26 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/ + w/o Contrast 721972 CDM 610 RC facility both TC 4609 4609 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Pelvis w/ + w/o Contrast 721972 CDM 610 RC facility both TC 4609 4609 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/ + w/o Contrast 721973 CDM 610 RC facility both TC 4609 4609 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/ + w/o Contrast 721973 CDM 610 RC facility both TC 4609 4609 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/ + w/o Contrast - Report 721974 CDM 972 RC 72197 HCPCS facility both 26 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Sacrum/Coccyx w/ + w/o Contrast - Report 721974 CDM 972 RC 72197 HCPCS facility both 26 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joints 1 or 2 Views - Report 722001 CDM 972 RC 72200 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joints 1 or 2 Views - Report 722001 CDM 972 RC 72200 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joints 1 or 2 Views 722002 CDM 320 RC facility both TC 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joints 1 or 2 Views 722002 CDM 320 RC facility both TC 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joints 3+ Views - Report 722021 CDM 972 RC 72202 HCPCS facility both 26 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joints 3+ Views - Report 722021 CDM 972 RC 72202 HCPCS facility both 26 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joints 3+ Views 722022 CDM 320 RC facility both TC 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacroiliac Joints 3+ Views 722022 CDM 320 RC facility both TC 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price bacitracin/neomycin/polymyxin B Top Oint [INYO] 7222 CDM 45802-0143-01 NDC facility both 1 EA 21.25 21.25 Gross Charge Type: Pharmacy | NDC EA = 14 APP bacitracin/neomycin/polymyxin B Top Oint [INYO] 7222 CDM 61269-0179-34 NDC facility both 1 EA 20.45 20.45 Gross Charge Type: Pharmacy | NDC EA = 14 APP bacitracin/neomycin/polymyxin B Top Oint [INYO] 7222 CDM 00081-0730-88 NDC facility both 1 EA 19.62 19.62 Gross Charge Type: Pharmacy | NDC EA = 14 APP bacitracin/neomycin/polymyxin B Top Oint [INYO] 7222 CDM 00472-0179-34 NDC facility both 1 EA 25.11 25.11 Gross Charge Type: Pharmacy | NDC EA = 14 APP XR Sacrum/Coccyx 2+ Views - Report 722201 CDM 972 RC 72220 HCPCS facility both 26 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacrum/Coccyx 2+ Views - Report 722201 CDM 972 RC 72220 HCPCS facility both 26 136 136 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacrum/Coccyx 2+ Views 722202 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Sacrum/Coccyx 2+ Views 722202 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price "PESSARY, GELLHORN SHORT STEM SZ1" 7223401 CDM facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price "PESSARY, GELLHORN SHORT STEM SZ1" 7223401 CDM facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price nitroprusside 25 mg/mL IV Sol [INYO] 7224 CDM 14789-0012-02 NDC facility both 2 ML 768 768 Gross Charge Type: Pharmacy sodium nitroprusside 25 mg/mL Sol [inyo] 7224 CDM 70436-0028-80 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy nitroprusside 25 mg/mL IV Sol [INYO] 7224 CDM 70069-0261-01 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy nitroprusside 25 mg/mL IV Sol [INYO] 7224 CDM 71288-0202-02 NDC facility both 2 ML 288 288 Gross Charge Type: Pharmacy nitroprusside 25 mg/mL IV Sol [INYO] 7224 CDM 00187-4302-02 NDC facility both 2 ML 2160 2160 Gross Charge Type: Pharmacy XR Myelogram Cervical Spine - Report 722401 CDM 972 RC 72240 HCPCS facility both 26 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Cervical Spine - Report 722401 CDM 972 RC 72240 HCPCS facility both 26 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Cervical Spine 722402 CDM 320 RC facility both TC 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Cervical Spine 722402 CDM 320 RC facility both TC 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Thoracic Spine 722552 CDM 320 RC facility both TC 1676 1676 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Thoracic Spine 722552 CDM 320 RC facility both TC 1676 1676 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Lumbosacral Spine - Report 722651 CDM 972 RC 72265 HCPCS facility both 26 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Lumbosacral Spine - Report 722651 CDM 972 RC 72265 HCPCS facility both 26 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Lumbosacral Spine 722652 CDM 320 RC facility both TC 1859 1859 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram Lumbosacral Spine 722652 CDM 320 RC facility both TC 1859 1859 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram 2 or More Regions w/ Inject 722701 CDM 320 RC facility both TC 2295 2295 Gross Charge Type: NIHD_Hosp_Profee_Price XR Myelogram 2 or More Regions w/ Inject 722701 CDM 320 RC facility both TC 2295 2295 Gross Charge Type: NIHD_Hosp_Profee_Price electrolyte replacement Oral Sol 1000mL [INYO] 7231 CDM 56069-0006-00 NDC facility both 1000 ML 26.46 26.46 Gross Charge Type: Pharmacy electrolyte replacement Oral Sol 1000 mL [INYO] 7231 CDM 70074-0802-40 NDC facility both 1000 ML 33.72 33.72 Gross Charge Type: Pharmacy electrolyte replacement Oral Sol 1000 mL [INYO] 7231 CDM 70074-0643-02 NDC facility both 1000 ML 33.72 33.72 Gross Charge Type: Pharmacy VALVE HEIMLICH S/SU CHEST DRAINAGE 723373 CDM 272 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price VALVE HEIMLICH S/SU CHEST DRAINAGE 723373 CDM 272 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price carboprost 250 mcg/mL Inj Sol [INYO] 7244 CDM 1 HCPCS 00009-0856-08 NDC facility both 1 ML 2551.92 2551.92 Gross Charge Type: Pharmacy carboprost 250 mcg/mL Inj Sol [INYO] 7244 CDM 1 HCPCS 43598-0698-58 NDC facility both 1 ML 2296.73 2296.73 Gross Charge Type: Pharmacy CV Stress Report 7252741 CDM 985 RC 93018 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price CV Stress Report 7252741 CDM 985 RC 93018 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price carbachol Ophth 0.01% Sol [INYO] 7268 CDM 00065-0023-15 NDC facility both 1 EA 218.52 218.52 Gross Charge Type: Pharmacy | NDC EA = 1.5 DROPS carBAMazepine 200 mg Tab [INYO] 7269 CDM 13668-0268-01 NDC facility both 1 EA 10.1 10.1 Gross Charge Type: Pharmacy | NDC EA = 1 TAB captopril 25 mg Tab [INYO] 7277 CDM 51079-0864-20 NDC facility both 1 EA 11.18 11.18 Gross Charge Type: Pharmacy | NDC EA = 1 TAB doxycycline 100 mg IV Inj [INYO] 7281 CDM 68382-0910-10 NDC facility both 1 EA 241.6 241.6 Gross Charge Type: Pharmacy doxycycline 100 mg IV Inj [INYO] 7281 CDM 67457-0437-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy XR Clavicle Left - Report 730001 CDM 972 RC 73000 HCPCS facility both 26LT 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Clavicle Left - Report 730001 CDM 972 RC 73000 HCPCS facility both 26LT 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Clavicle Right - Report 730002 CDM 972 RC 73000 HCPCS facility both 26RT 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Clavicle Right - Report 730002 CDM 972 RC 73000 HCPCS facility both 26RT 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Clavicle Left 730003 CDM 320 RC facility both TCLT 382 382 Gross Charge Type: NIHD_Hosp_Profee_Price XR Clavicle Left 730003 CDM 320 RC facility both TCLT 382 382 Gross Charge Type: NIHD_Hosp_Profee_Price XR Clavicle Right 730004 CDM 320 RC facility both TCRT 382 382 Gross Charge Type: NIHD_Hosp_Profee_Price XR Clavicle Right 730004 CDM 320 RC facility both TCRT 382 382 Gross Charge Type: NIHD_Hosp_Profee_Price XR Scapula Right - Report 730101 CDM 972 RC 73010 HCPCS facility both 26RT 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price XR Scapula Right - Report 730101 CDM 972 RC 73010 HCPCS facility both 26RT 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price XR Scapula Left - Report 730102 CDM 972 RC 73010 HCPCS facility both 26LT 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price XR Scapula Left - Report 730102 CDM 972 RC 73010 HCPCS facility both 26LT 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price XR Scapula Left 730103 CDM 320 RC facility both TCLT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Scapula Left 730103 CDM 320 RC facility both TCLT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Scapula Right 730104 CDM 320 RC facility both TCRT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Scapula Right 730104 CDM 320 RC facility both TCRT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder 1 View Right - Report 730201 CDM 972 RC 73020 HCPCS facility both 26RT 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder 1 View Right - Report 730201 CDM 972 RC 73020 HCPCS facility both 26RT 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder 1 View Left - Report 730202 CDM 972 RC 73020 HCPCS facility both 26LT 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder 1 View Left - Report 730202 CDM 972 RC 73020 HCPCS facility both 26LT 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder 1 View Left 730203 CDM 320 RC facility both TCLT 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder 1 View Left 730203 CDM 320 RC facility both TCLT 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder 1 View Right 730204 CDM 320 RC facility both TCRT 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder 1 View Right 730204 CDM 320 RC facility both TCRT 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder Complete 2+ Views Right - Report 730301 CDM 972 RC 73030 HCPCS facility both 26RT 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder Complete 2+ Views Right - Report 730301 CDM 972 RC 73030 HCPCS facility both 26RT 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder Complete 2+ Views Left - Report 730302 CDM 972 RC 73030 HCPCS facility both 26LT 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder Complete 2+ Views Left - Report 730302 CDM 972 RC 73030 HCPCS facility both 26LT 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder Complete 2+ Views Left 730303 CDM 320 RC facility both TCLT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder Complete 2+ Views Left 730303 CDM 320 RC facility both TCLT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder Complete 2+ Views Right 730304 CDM 320 RC facility both TCRT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shoulder Complete 2+ Views Right 730304 CDM 320 RC facility both TCRT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Shoulder Left 730401 CDM 322 RC facility both TCLT 1084 1084 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Shoulder Left 730401 CDM 322 RC facility both TCLT 1084 1084 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Shoulder Right 730403 CDM 322 RC facility both TCRT 1084 1084 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Shoulder Right 730403 CDM 322 RC facility both TCRT 1084 1084 Gross Charge Type: NIHD_Hosp_Profee_Price XR AC Joints Bilateral - Report 730501 CDM 972 RC 73050 HCPCS facility both 2650 59 59 Gross Charge Type: NIHD_Hosp_Profee_Price XR AC Joints Bilateral - Report 730501 CDM 972 RC 73050 HCPCS facility both 2650 59 59 Gross Charge Type: NIHD_Hosp_Profee_Price XR AC Joints Bilateral 730502 CDM 320 RC facility both TC 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR AC Joints Bilateral 730502 CDM 320 RC facility both TC 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Humerus Right - Report 730601 CDM 972 RC 73060 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Humerus Right - Report 730601 CDM 972 RC 73060 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Humerus Left - Report 730602 CDM 972 RC 73060 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Humerus Left - Report 730602 CDM 972 RC 73060 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Humerus Left 730603 CDM 320 RC facility both TCLT 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price XR Humerus Left 730603 CDM 320 RC facility both TCLT 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price XR Humerus Right 730604 CDM 320 RC facility both TCRT 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price XR Humerus Right 730604 CDM 320 RC facility both TCRT 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow 2 Views Right - Report 730701 CDM 972 RC 73070 HCPCS facility both 26RT 62 62 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow 2 Views Right - Report 730701 CDM 972 RC 73070 HCPCS facility both 26RT 62 62 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow 2 Views Left - Report 730702 CDM 972 RC 73070 HCPCS facility both 26LT 62 62 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow 2 Views Left - Report 730702 CDM 972 RC 73070 HCPCS facility both 26LT 62 62 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow 2 Views Left 730703 CDM 320 RC facility both TCLT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow 2 Views Left 730703 CDM 320 RC facility both TCLT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow 2 Views Right 730704 CDM 320 RC facility both TCRT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow 2 Views Right 730704 CDM 320 RC facility both TCRT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow Complete 3+ Views Right - Report 730801 CDM 972 RC 73080 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow Complete 3+ Views Right - Report 730801 CDM 972 RC 73080 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow Complete 3+ Views Left - Report 730802 CDM 972 RC 73080 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow Complete 3+ Views Left - Report 730802 CDM 972 RC 73080 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow Complete 3+ Views Left 730803 CDM 320 RC facility both TCLT 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow Complete 3+ Views Left 730803 CDM 320 RC facility both TCLT 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow Complete 3+ Views Right 730804 CDM 320 RC facility both TCRT 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XR Elbow Complete 3+ Views Right 730804 CDM 320 RC facility both TCRT 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price 73080 XR ELBOW CMPLT MIN 3V BILAT 730805 CDM 320 RC facility both 50TC 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price 73080 XR ELBOW CMPLT MIN 3V BILAT 730805 CDM 320 RC facility both 50TC 900 900 Gross Charge Type: NIHD_Hosp_Profee_Price 73080 XR ELBOW CMPLT MIN 3V BIL: PROF 730806 CDM 972 RC 73080 HCPCS facility both 2650 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price 73080 XR ELBOW CMPLT MIN 3V BIL: PROF 730806 CDM 972 RC 73080 HCPCS facility both 2650 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price XR Forearm 2 Views Right - Report 730901 CDM 972 RC 73090 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Forearm 2 Views Right - Report 730901 CDM 972 RC 73090 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Forearm 2 Views Left - Report 730902 CDM 972 RC 73090 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Forearm 2 Views Left - Report 730902 CDM 972 RC 73090 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Forearm 2 Views Left 730903 CDM 320 RC facility both TCLT 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price XR Forearm 2 Views Left 730903 CDM 320 RC facility both TCLT 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price XR Forearm 2 Views Right 730904 CDM 320 RC facility both TCRT 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price XR Forearm 2 Views Right 730904 CDM 320 RC facility both TCRT 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper Extremity Infant (0-1yr) Left - Report 730921 CDM 972 RC 73092 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper Extremity Infant (0-1yr) Left - Report 730921 CDM 972 RC 73092 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper Extremity Infant (0-1yr) Right - Report 730922 CDM 972 RC 73092 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper Extremity Infant (0-1yr) Right - Report 730922 CDM 972 RC 73092 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper Extremity Infant (0-1yr) Left 730923 CDM 320 RC facility both TCLT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper Extremity Infant (0-1yr) Left 730923 CDM 320 RC facility both TCLT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper Extremity Infant (0-1yr) Right 730924 CDM 320 RC facility both TCRT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper Extremity Infant (0-1yr) Right 730924 CDM 320 RC facility both TCRT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist 2 Views Left - Report 731001 CDM 972 RC 73100 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist 2 Views Left - Report 731001 CDM 972 RC 73100 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist 2 Views Right - Report 731002 CDM 972 RC 73100 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist 2 Views Right - Report 731002 CDM 972 RC 73100 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist 2 Views Left 731003 CDM 320 RC facility both TCLT 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist 2 Views Left 731003 CDM 320 RC facility both TCLT 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist 2 Views Right 731004 CDM 320 RC facility both TCRT 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist 2 Views Right 731004 CDM 320 RC facility both TCRT 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist Complete 3+ Views Right - Report 731101 CDM 972 RC 73110 HCPCS facility both 26RT 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist Complete 3+ Views Right - Report 731101 CDM 972 RC 73110 HCPCS facility both 26RT 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist Complete 3+ Views Left - Report 731102 CDM 972 RC 73110 HCPCS facility both 26LT 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist Complete 3+ Views Left - Report 731102 CDM 972 RC 73110 HCPCS facility both 26LT 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist Complete 3+ Views Left 731103 CDM 320 RC facility both TCLT 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist Complete 3+ Views Left 731103 CDM 320 RC facility both TCLT 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist Complete 3+ Views Right 731104 CDM 320 RC facility both TCRT 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XR Wrist Complete 3+ Views Right 731104 CDM 320 RC facility both TCRT 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Right - Report 731201 CDM 972 RC 73120 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Right - Report 731201 CDM 972 RC 73120 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Left - Report 731202 CDM 972 RC 73120 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Left - Report 731202 CDM 972 RC 73120 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Bilateral - Report 731203 CDM 972 RC 73120 HCPCS facility both 2650 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Bilateral - Report 731203 CDM 972 RC 73120 HCPCS facility both 2650 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Bilateral 731204 CDM 320 RC facility both TC 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Bilateral 731204 CDM 320 RC facility both TC 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Left 731205 CDM 320 RC facility both TCLT 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Left 731205 CDM 320 RC facility both TCLT 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Right 731206 CDM 320 RC facility both TCRT 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand 2 Views Right 731206 CDM 320 RC facility both TCRT 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Right - Report 731301 CDM 972 RC 73130 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Right - Report 731301 CDM 972 RC 73130 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Left - Report 731302 CDM 972 RC 73130 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Left - Report 731302 CDM 972 RC 73130 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Bilateral - Report 731303 CDM 972 RC 73130 HCPCS facility both 2650 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Bilateral - Report 731303 CDM 972 RC 73130 HCPCS facility both 2650 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Bilateral 731304 CDM 320 RC facility both TC 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Bilateral 731304 CDM 320 RC facility both TC 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Left 731305 CDM 320 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Left 731305 CDM 320 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Right 731306 CDM 320 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hand Complete 3+ Views Right 731306 CDM 320 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price Fingers minimum of 2 Views 731402 CDM 320 RC facility both TCLT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price Fingers minimum of 2 Views 731402 CDM 320 RC facility both TCLT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Right 731404 CDM 320 RC facility both TCRT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Right 731404 CDM 320 RC facility both TCRT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Left 731405 CDM 320 RC facility both TCLT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Left 731405 CDM 320 RC facility both TCLT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Left - Report 731406 CDM 972 RC 73140 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Left - Report 731406 CDM 972 RC 73140 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Right 731407 CDM 320 RC facility both TCRT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Right 731407 CDM 320 RC facility both TCRT 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Right - Report 731408 CDM 972 RC 73140 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Finger(s) 2+ Views Right - Report 731408 CDM 972 RC 73140 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/o Contrast Left - Report 732001 CDM 972 RC 73200 HCPCS facility both 26LT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/o Contrast Left - Report 732001 CDM 972 RC 73200 HCPCS facility both 26LT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/o Contrast Right - Report 732002 CDM 972 RC 73200 HCPCS facility both 26RT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/o Contrast Right - Report 732002 CDM 972 RC 73200 HCPCS facility both 26RT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/o Contrast Left 732003 CDM 352 RC facility both TCLT 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/o Contrast Left 732003 CDM 352 RC facility both TCLT 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/o Contrast Right 732004 CDM 352 RC facility both TCRT 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/o Contrast Right 732004 CDM 352 RC facility both TCRT 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price 73200 CT Upper Extremity w/o Contrast Bilat 732005 CDM 352 RC facility both TC50 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price 73200 CT Upper Extremity w/o Contrast Bilat 732005 CDM 352 RC facility both TC50 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price 73200 CT Upper Extremity w/o Contrast Bilat PROFEE 732006 CDM 972 RC 73200 HCPCS facility both 2650 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 73200 CT Upper Extremity w/o Contrast Bilat PROFEE 732006 CDM 972 RC 73200 HCPCS facility both 2650 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/ Contrast Left - Report 732011 CDM 972 RC 73201 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/ Contrast Left - Report 732011 CDM 972 RC 73201 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/ Contrast Right - Report 732012 CDM 972 RC 73201 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/ Contrast Right - Report 732012 CDM 972 RC 73201 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/ Contrast Left 732013 CDM 352 RC facility both TCLT 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/ Contrast Left 732013 CDM 352 RC facility both TCLT 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/ Contrast Right 732014 CDM 352 RC facility both TCRT 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/ Contrast Right 732014 CDM 352 RC facility both TCRT 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/+w/o Contrast Left 732023 CDM 350 RC facility both TCLT 2561 2561 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/+w/o Contrast Left 732023 CDM 350 RC facility both TCLT 2561 2561 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/+w/o Contrast Right 732024 CDM 350 RC facility both TCRT 2561 2561 Gross Charge Type: NIHD_Hosp_Profee_Price CT Upper Extremity w/+w/o Contrast Right 732024 CDM 350 RC facility both TCRT 2561 2561 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Upper Extremity Left - Report 732061 CDM 972 RC 73206 HCPCS facility both 26LT 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Upper Extremity Left - Report 732061 CDM 972 RC 73206 HCPCS facility both 26LT 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Upper Extremity Right - Report 732062 CDM 972 RC 73206 HCPCS facility both 26RT 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Upper Extremity Right - Report 732062 CDM 972 RC 73206 HCPCS facility both 26RT 936 936 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Upper Extremity Left 732063 CDM 352 RC facility both TCLT 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Upper Extremity Left 732063 CDM 352 RC facility both TCLT 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Upper Extremity Right 732064 CDM 352 RC facility both TCRT 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Upper Extremity Right 732064 CDM 352 RC facility both TCRT 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/o Contrast Left 732181 CDM 610 RC facility both TCLT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/o Contrast Left 732181 CDM 610 RC facility both TCLT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/o Contrast Left - Report 7321810 CDM 972 RC 73218 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/o Contrast Left - Report 7321810 CDM 972 RC 73218 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/o Contrast Right 7321811 CDM 610 RC facility both TCRT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/o Contrast Right 7321811 CDM 610 RC facility both TCRT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/o Contrast Right - Report 7321812 CDM 972 RC 73218 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/o Contrast Right - Report 7321812 CDM 972 RC 73218 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/o Contrast Lt - Report 7321813 CDM 972 RC 73218 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/o Contrast Lt - Report 7321813 CDM 972 RC 73218 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/o Contrast Rt - Report 7321814 CDM 972 RC 73218 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/o Contrast Rt - Report 7321814 CDM 972 RC 73218 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/o Contrast Lt 7321815 CDM 610 RC facility both TCLT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/o Contrast Lt 7321815 CDM 610 RC facility both TCLT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/o Contrast Rt 7321816 CDM 610 RC facility both TCRT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/o Contrast Rt 7321816 CDM 610 RC facility both TCRT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/o Contrast Left - Report 732182 CDM 972 RC 73218 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/o Contrast Left - Report 732182 CDM 972 RC 73218 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/o Contrast Right 732183 CDM 610 RC facility both TCRT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/o Contrast Right 732183 CDM 610 RC facility both TCRT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/o Contrast Right - Report 732184 CDM 972 RC 73218 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/o Contrast Right - Report 732184 CDM 972 RC 73218 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/o Contrast Left - Report 732185 CDM 972 RC 73218 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/o Contrast Left - Report 732185 CDM 972 RC 73218 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/o Contrast Right - Report 732186 CDM 972 RC 73218 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/o Contrast Right - Report 732186 CDM 972 RC 73218 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/o Contrast Left 732187 CDM 610 RC facility both TCLT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/o Contrast Left 732187 CDM 610 RC facility both TCLT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/o Contrast Right 732188 CDM 610 RC facility both TCRT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/o Contrast Right 732188 CDM 610 RC facility both TCRT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/o Contrast Left 732189 CDM 610 RC facility both TCLT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/o Contrast Left 732189 CDM 610 RC facility both TCLT 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ Contrast Left 732191 CDM 610 RC facility both TCLT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ Contrast Left 732191 CDM 610 RC facility both TCLT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ Contrast Right 7321911 CDM 610 RC facility both TCRT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ Contrast Right 7321911 CDM 610 RC facility both TCRT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ Contrast Lt 7321915 CDM 610 RC facility both TCLT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ Contrast Lt 7321915 CDM 610 RC facility both TCLT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ Contrast Rt 7321916 CDM 610 RC facility both TCRT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ Contrast Rt 7321916 CDM 610 RC facility both TCRT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ Contrast Right 732193 CDM 610 RC facility both TCRT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ Contrast Right 732193 CDM 610 RC facility both TCRT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ Contrast Left - Report 732195 CDM 972 RC 73219 HCPCS facility both 26LT 552 552 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ Contrast Left - Report 732195 CDM 972 RC 73219 HCPCS facility both 26LT 552 552 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ Contrast Left 732197 CDM 610 RC facility both TCLT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ Contrast Left 732197 CDM 610 RC facility both TCLT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ Contrast Right 732198 CDM 610 RC facility both TCRT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ Contrast Right 732198 CDM 610 RC facility both TCRT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ Contrast Left 732199 CDM 610 RC facility both TCLT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ Contrast Left 732199 CDM 610 RC facility both TCLT 3165 3165 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ + w/o Contrast Left 732201 CDM 610 RC facility both TCLT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ + w/o Contrast Left 732201 CDM 610 RC facility both TCLT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ + w/o Contrast Left - Report 7322010 CDM 972 RC 73220 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ + w/o Contrast Left - Report 7322010 CDM 972 RC 73220 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ + w/o Contrast Right 7322011 CDM 610 RC facility both TCRT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ + w/o Contrast Right 7322011 CDM 610 RC facility both TCRT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ + w/o Contrast Right - Report 7322012 CDM 972 RC 73220 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ + w/o Contrast Right - Report 7322012 CDM 972 RC 73220 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ + w/o Contrast Lt - Report 7322013 CDM 972 RC 73220 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ + w/o Contrast Lt - Report 7322013 CDM 972 RC 73220 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ + w/o Contrast Rt - Report 7322014 CDM 972 RC 73220 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ + w/o Contrast Rt - Report 7322014 CDM 972 RC 73220 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ + w/o Contrast Lt 7322015 CDM 610 RC facility both TCLT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ + w/o Contrast Lt 7322015 CDM 610 RC facility both TCLT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ + w/o Contrast Rt 7322016 CDM 610 RC facility both TCRT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI UE Non Joint w/ + w/o Contrast Rt 7322016 CDM 610 RC facility both TCRT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ + w/o Contrast Left - Report 732202 CDM 972 RC 73220 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ + w/o Contrast Left - Report 732202 CDM 972 RC 73220 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ + w/o Contrast Right 732203 CDM 610 RC facility both TCRT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ + w/o Contrast Right 732203 CDM 610 RC facility both TCRT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ + w/o Contrast Right - Report 732204 CDM 972 RC 73220 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Forearm w/ + w/o Contrast Right - Report 732204 CDM 972 RC 73220 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ + w/o Contrast Left - Report 732205 CDM 972 RC 73220 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ + w/o Contrast Left - Report 732205 CDM 972 RC 73220 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ + w/o Contrast Right - Report 732206 CDM 972 RC 73220 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ + w/o Contrast Right - Report 732206 CDM 972 RC 73220 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ + w/o Contrast Left 732207 CDM 610 RC facility both TCLT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ + w/o Contrast Left 732207 CDM 610 RC facility both TCLT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ + w/o Contrast Right 732208 CDM 610 RC facility both TCRT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hand w/ + w/o Contrast Right 732208 CDM 610 RC facility both TCRT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ + w/o Contrast Left 732209 CDM 610 RC facility both TCLT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Humerus w/ + w/o Contrast Left 732209 CDM 610 RC facility both TCLT 4242 4242 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/o Contrast Left - Report 732211 CDM 972 RC 73221 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/o Contrast Left - Report 732211 CDM 972 RC 73221 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/o Contrast Right - Report 7322110 CDM 972 RC 73221 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/o Contrast Right - Report 7322110 CDM 972 RC 73221 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/o Contrast Left 7322111 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/o Contrast Left 7322111 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/o Contrast Right 7322112 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/o Contrast Right 7322112 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/o Contrast Right - Report 732212 CDM 972 RC 73221 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/o Contrast Right - Report 732212 CDM 972 RC 73221 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/o Contrast Left 732213 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/o Contrast Left 732213 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/o Contrast Right 732214 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/o Contrast Right 732214 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/o Contrast Left - Report 732215 CDM 972 RC 73221 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/o Contrast Left - Report 732215 CDM 972 RC 73221 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/o Contrast Right - Report 732216 CDM 972 RC 73221 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/o Contrast Right - Report 732216 CDM 972 RC 73221 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/o Contrast Left 732217 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/o Contrast Left 732217 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/o Contrast Right 732218 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/o Contrast Right 732218 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/o Contrast Left - Report 732219 CDM 972 RC 73221 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/o Contrast Left - Report 732219 CDM 972 RC 73221 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow Arthrogram Left 732221 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow Arthrogram Left 732221 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ Contrast Right - Report 7322210 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ Contrast Right - Report 7322210 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ Contrast Left 7322211 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ Contrast Left 7322211 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ Contrast Right 7322212 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ Contrast Right 7322212 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder Arthrogram Left 7322213 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder Arthrogram Left 7322213 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder Arthrogram Left - Report 7322214 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder Arthrogram Left - Report 7322214 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder Arthrogram Right 7322215 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder Arthrogram Right 7322215 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder Arthrogram Right - Report 7322216 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder Arthrogram Right - Report 7322216 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist Arthrogram Left 7322217 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist Arthrogram Left 7322217 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist Arthrogram Left - Report 7322218 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist Arthrogram Left - Report 7322218 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist Arthrogram Right 7322219 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist Arthrogram Right 7322219 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow Arthrogram Left - Report 732222 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow Arthrogram Left - Report 732222 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist Arthrogram Right - Report 7322220 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist Arthrogram Right - Report 7322220 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ Contrast Left - Report 7322221 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ Contrast Left - Report 7322221 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ Contrast Right - Report 7322222 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ Contrast Right - Report 7322222 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ Contrast Left 7322223 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ Contrast Left 7322223 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ Contrast Right 7322224 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ Contrast Right 7322224 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow Arthrogram Right 732223 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow Arthrogram Right 732223 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow Arthrogram Right - Report 732224 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow Arthrogram Right - Report 732224 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ Contrast Left - Report 732225 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ Contrast Left - Report 732225 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ Contrast Right - Report 732226 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ Contrast Right - Report 732226 CDM 972 RC 73222 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ Contrast Left 732227 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ Contrast Left 732227 CDM 610 RC facility both TCLT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ Contrast Right 732228 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ Contrast Right 732228 CDM 610 RC facility both TCRT 3520 3520 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ Contrast Left - Report 732229 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ Contrast Left - Report 732229 CDM 972 RC 73222 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ + w/o Contrast Left - Report 732231 CDM 972 RC 73223 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ + w/o Contrast Left - Report 732231 CDM 972 RC 73223 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ + w/o Contrast Right - Report 7322310 CDM 972 RC 73223 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ + w/o Contrast Right - Report 7322310 CDM 972 RC 73223 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ + w/o Contrast Left 7322311 CDM 610 RC facility both TCLT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ + w/o Contrast Left 7322311 CDM 610 RC facility both TCLT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ + w/o Contrast Right 7322312 CDM 610 RC facility both TCRT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ + w/o Contrast Right 7322312 CDM 610 RC facility both TCRT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ + w/o Contrast Right - Report 732232 CDM 972 RC 73223 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ + w/o Contrast Right - Report 732232 CDM 972 RC 73223 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ + w/o Contrast Left 732233 CDM 610 RC facility both TCLT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ + w/o Contrast Left 732233 CDM 610 RC facility both TCLT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ + w/o Contrast Right 732234 CDM 610 RC facility both TCRT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Elbow w/ + w/o Contrast Right 732234 CDM 610 RC facility both TCRT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ + w/o Contrast Left - Report 732235 CDM 972 RC 73223 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ + w/o Contrast Left - Report 732235 CDM 972 RC 73223 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ + w/o Contrast Right - Report 732236 CDM 972 RC 73223 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ + w/o Contrast Right - Report 732236 CDM 972 RC 73223 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ + w/o Contrast Left 732237 CDM 610 RC facility both TCLT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ + w/o Contrast Left 732237 CDM 610 RC facility both TCLT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ + w/o Contrast Right 732238 CDM 610 RC facility both TCRT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Shoulder w/ + w/o Contrast Right 732238 CDM 610 RC facility both TCRT 4420 4420 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ + w/o Contrast Left - Report 732239 CDM 972 RC 73223 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Wrist w/ + w/o Contrast Left - Report 732239 CDM 972 RC 73223 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Upper Extremity w/ + w/o Cnt Left 732251 CDM 610 RC facility both TCLT 481 481 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Upper Extremity w/ + w/o Cnt Left 732251 CDM 610 RC facility both TCLT 481 481 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Upper Extremity w/ + w/o Cnt Right 732253 CDM 610 RC facility both TCRT 481 481 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Upper Extremity w/ + w/o Cnt Right 732253 CDM 610 RC facility both TCRT 481 481 Gross Charge Type: NIHD_Hosp_Profee_Price "PESSARY, GELLHORN SHORT STEM SZ0" 7328621 CDM facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price "PESSARY, GELLHORN SHORT STEM SZ0" 7328621 CDM facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View Right - Report 735011 CDM 972 RC 73501 HCPCS facility both 26RT 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View Right - Report 735011 CDM 972 RC 73501 HCPCS facility both 26RT 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View Left - Report 735012 CDM 972 RC 73501 HCPCS facility both 26LT 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View Left - Report 735012 CDM 972 RC 73501 HCPCS facility both 26LT 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View Left 735013 CDM 320 RC facility both TC 309 309 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View Left 735013 CDM 320 RC facility both TC 309 309 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View Right 735014 CDM 320 RC facility both TC 309 309 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View Right 735014 CDM 320 RC facility both TC 309 309 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View w/ AP Pelvis Bilateral 735015 CDM 320 RC facility both TC 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View w/ AP Pelvis Bilateral 735015 CDM 320 RC facility both TC 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View w/ AP Pelvis Bilateral - Report 735016 CDM 972 RC 73501 HCPCS facility both 26 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 1 View w/ AP Pelvis Bilateral - Report 735016 CDM 972 RC 73501 HCPCS facility both 26 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 2-3 Views Left 73502_320 CDM 320 RC facility both TCLT 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 2-3 Views Left 73502_320 CDM 320 RC facility both TCLT 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 2-3 Views Left - Report 73502_972 CDM 972 RC 73502 HCPCS facility both 26LT 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 2-3 Views Left - Report 73502_972 CDM 972 RC 73502 HCPCS facility both 26LT 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips Min 5 Views w/AP Pelvis Bilat 735021 CDM 320 RC facility both TC50 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips Min 5 Views w/AP Pelvis Bilat 735021 CDM 320 RC facility both TC50 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips Min 5 Views Views w/AP Pelvis Bilat - Report 735022 CDM 972 RC 73502 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips Min 5 Views Views w/AP Pelvis Bilat - Report 735022 CDM 972 RC 73502 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 2-3 Views Right - Report 735023 CDM 972 RC 73502 HCPCS facility both 26RT 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 2-3 Views Right - Report 735023 CDM 972 RC 73502 HCPCS facility both 26RT 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 2-3 Views Right 735024 CDM 320 RC facility both TCRT 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 2-3 Views Right 735024 CDM 320 RC facility both TCRT 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price 73502 XR Hip 2-3 Views w/AP Pelvis Right 735025 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price 73502 XR Hip 2-3 Views w/AP Pelvis Right 735025 CDM 320 RC facility both TC 429 429 Gross Charge Type: NIHD_Hosp_Profee_Price 73502 XR Hip 2-3 Views w/AP Pelvis Right PROFEE 735026 CDM 972 RC 73502 HCPCS facility both 26 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price 73502 XR Hip 2-3 Views w/AP Pelvis Right PROFEE 735026 CDM 972 RC 73502 HCPCS facility both 26 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 4+ Views Left 735031 CDM 320 RC facility both TCLT 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 4+ Views Left 735031 CDM 320 RC facility both TCLT 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 4+ Views Left - Report 735032 CDM 972 RC 73503 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 4+ Views Left - Report 735032 CDM 972 RC 73503 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 4+ Views Right 735033 CDM 320 RC facility both TCRT 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 4+ Views Right 735033 CDM 320 RC facility both TCRT 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 4+ Views Right - Report 735034 CDM 972 RC 73503 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hip 4+ Views Right - Report 735034 CDM 972 RC 73503 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price 73503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS 735035 CDM 320 RC facility both TC 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price 73503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS 735035 CDM 320 RC facility both TC 592 592 Gross Charge Type: NIHD_Hosp_Profee_Price 73503 XR HIP W/ PELVIS MIN 4 VIEWS PRO FEE 735036 CDM 972 RC 73503 HCPCS facility both 26 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price 73503 XR HIP W/ PELVIS MIN 4 VIEWS PRO FEE 735036 CDM 972 RC 73503 HCPCS facility both 26 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Chloride 0.45% IV Sol 1000 mL [INYO] 73512 CDM 00264-7802-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy LVP solution Sodium Chloride 0.45% Sol [inyo] 73512 CDM 00990-7985-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.45% IV Sol 1000 mL [INYO] 73512 CDM 63323-0626-10 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.45% IV Sol 1000 mL [INYO] 73512 CDM 00409-7985-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.45% IV Sol 500 mL [INYO] 73513 CDM 00409-7985-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 500 mL [INYO] 73515 CDM J7060 HCPCS 00264-7510-10 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 500 mL [INYO] 73515 CDM J7060 HCPCS 00409-7922-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 500 mL [INYO] 73515 CDM J7060 HCPCS 00338-0017-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with NS IV Sol 1000 mL [INYO] 73516 CDM J7042 HCPCS 00990-7941-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy LVP solution Dextrose 5% with 0.9% NaCl Sol [inyo] 73516 CDM J7042 HCPCS 00338-0089-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with NS IV Sol 1000 mL [INYO] 73516 CDM J7042 HCPCS 00264-7610-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl IV Sol 500 mL [INYO] 73517 CDM 00409-7926-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 150 mL [INYO] 73519 CDM J7040 HCPCS 00990-7983-61 NDC facility both 150 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 150 mL [INYO] 73519 CDM J7040 HCPCS 00409-7983-61 NDC facility both 150 ML 275 275 Gross Charge Type: Pharmacy XR Hips 2 Views Bilat 735211 CDM 320 RC facility both TC 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 2 Views Bilat 735211 CDM 320 RC facility both TC 576 576 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 2 Views Bilat - Report 735212 CDM 972 RC 73521 HCPCS facility both 26 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 2 Views Bilat - Report 735212 CDM 972 RC 73521 HCPCS facility both 26 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Dextrose 5% with 0.225% NaCl IV Sol 1000 mL [INYO] 73522 CDM 00409-7924-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy XR Hips 3-4 Views Bilat 735221 CDM 320 RC facility both TC 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 3-4 Views Bilat 735221 CDM 320 RC facility both TC 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 3-4 Views Bilat - Report 735222 CDM 972 RC 73522 HCPCS facility both 2650 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 3-4 Views Bilat - Report 735222 CDM 972 RC 73522 HCPCS facility both 2650 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 5+ Views Bilat 735231 CDM 320 RC facility both TC 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 5+ Views Bilat 735231 CDM 320 RC facility both TC 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 5+ Views Bilat - Report 735232 CDM 972 RC 73523 HCPCS facility both 2650 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hips 5+ Views Bilat - Report 735232 CDM 972 RC 73523 HCPCS facility both 2650 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Chloride 0.9% IV Sol 50 mL [INYO] 73524 CDM J7040 HCPCS 00264-1800-31 NDC facility both 50 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 50 mL [INYO] 73524 CDM J7040 HCPCS 00409-7984-13 NDC facility both 50 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 50 mL [INYO] 73524 CDM J7040 HCPCS 00338-0049-41 NDC facility both 50 ML 275 275 Gross Charge Type: Pharmacy zzNIHD US GUIDE FOR VASCULAR ACCESS 73525 CDM 322 RC facility both TC 1131 1131 Gross Charge Type: NIHD_Hosp_Profee_Price zzNIHD US GUIDE FOR VASCULAR ACCESS 73525 CDM 322 RC facility both TC 1131 1131 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Chloride 0.9% IV Sol 25 mL [INYO] 73526 CDM J7040 HCPCS 00990-7984-20 NDC facility both 25 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 25 mL [INYO] 73526 CDM J7040 HCPCS 00338-0049-10 NDC facility both 25 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 25 mL [INYO] 73526 CDM J7040 HCPCS 00409-7984-20 NDC facility both 25 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 250 mL [INYO] 73527 CDM J7060 HCPCS 00264-7510-20 NDC facility both 250 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 250 mL [INYO] 73527 CDM J7060 HCPCS 00338-0017-02 NDC facility both 250 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 250 mL [INYO] 73527 CDM J7060 HCPCS 00409-7922-02 NDC facility both 250 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 250 mL [INYO] 73527 CDM J7060 HCPCS 00409-7100-02 NDC facility both 250 ML 275 275 Gross Charge Type: Pharmacy LVP solution Dextrose 5% with 0.45% NaCl Sol [inyo] 73528 CDM 00264-7612-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl IV Sol 1000 mL [INYO] 73528 CDM 00409-7926-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 1000 mL [INYO] 73529 CDM J7060 HCPCS 00338-0017-04 NDC facility both 1000 ML 265 265 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 1000 mL [INYO] 73529 CDM J7060 HCPCS 00264-7510-00 NDC facility both 1000 ML 265 265 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 25 mL [INYO] 73531 CDM J7060 HCPCS 00409-7923-20 NDC facility both 25 ML 170 170 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 100 mL [INYO] 73532 CDM J7060 HCPCS 00264-1510-32 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 50 mL [INYO] 73533 CDM J7060 HCPCS 00264-1510-31 NDC facility both 50 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 150 mL [INYO] 73534 CDM J7060 HCPCS 00409-7922-61 NDC facility both 150 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water IV Sol 150 mL [INYO] 73534 CDM J7060 HCPCS 00990-7922-61 NDC facility both 150 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Lactated Ringers IV Sol 1000 mL [INYO] 73536 CDM J7121 HCPCS 00264-7751-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy LVP solution Dextrose 5% in Lactated Ringers Injection Sol 73536 CDM J7121 HCPCS 00338-0125-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy magnesium sulfate 20 g/500mL-sterile water Sol 73537 CDM J3475 HCPCS 63323-0106-15 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy magnesium sulfate 20 g/500mL-sterile water [INYO] 73537 CDM J3475 HCPCS 00409-6729-03 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy traMADol 50 mg Tab [inyo] 73548 CDM 00904-7179-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB traMADol 50 mg Tab [INYO] 73548 CDM 00904-6365-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB traMADol 50 mg Tab [INYO] 73548 CDM 68084-0808-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB traMADol 50 mg Tab [INYO] 73548 CDM 51079-0991-20 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB XR Femur 1 View Left 735511 CDM 320 RC facility both TCLT 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 1 View Left 735511 CDM 320 RC facility both TCLT 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 1 View Left - Report 735512 CDM 972 RC 73551 HCPCS facility both 26LT 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 1 View Left - Report 735512 CDM 972 RC 73551 HCPCS facility both 26LT 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 1 View Right 735513 CDM 320 RC facility both TCRT 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 1 View Right 735513 CDM 320 RC facility both TCRT 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 1 View Right - Report 735514 CDM 972 RC 73551 HCPCS facility both 26RT 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 1 View Right - Report 735514 CDM 972 RC 73551 HCPCS facility both 26RT 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price benazepril 10 mg Tab [INYO] 73552 CDM 50268-0110-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB benazepril 10 mg Tab [INYO] 73552 CDM 51079-0145-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB XR Femur 2 Views Left 735521 CDM 320 RC facility both TCLT 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 2 Views Left 735521 CDM 320 RC facility both TCLT 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 2 Views Left - Report 735522 CDM 972 RC 73552 HCPCS facility both 26LT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 2 Views Left - Report 735522 CDM 972 RC 73552 HCPCS facility both 26LT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 2 Views Right 735523 CDM 320 RC facility both TCRT 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 2 Views Right 735523 CDM 320 RC facility both TCRT 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 2 Views Right - Report 735524 CDM 972 RC 73552 HCPCS facility both 26RT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Femur 2 Views Right - Report 735524 CDM 972 RC 73552 HCPCS facility both 26RT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price aspirin 81 mg Oral EC Tab [INYO] 73553 CDM 63739-0212-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 81 mg Oral EC Tab [INYO] 73553 CDM 42037-0103-75 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 81 mg Oral EC Tab [INYO] 73553 CDM 00904-6783-70 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aspirin 81 mg Oral EC Tab [INYO] 73553 CDM 63739-0522-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB XR Knee 1 or 2 Views Right - Report 735601 CDM 972 RC 73560 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 or 2 Views Right - Report 735601 CDM 972 RC 73560 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 or 2 Views Left - Report 735602 CDM 972 RC 73560 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 or 2 Views Left - Report 735602 CDM 972 RC 73560 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 or 2 Views Left 735603 CDM 320 RC facility both TCLT 388 388 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 or 2 Views Left 735603 CDM 320 RC facility both TCLT 388 388 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 or 2 Views Right 735604 CDM 320 RC facility both TCRT 388 388 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 or 2 Views Right 735604 CDM 320 RC facility both TCRT 388 388 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 3 Views Right - Report 735621 CDM 972 RC 73562 HCPCS facility both 26RT 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 3 Views Right - Report 735621 CDM 972 RC 73562 HCPCS facility both 26RT 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 3 Views Left - Report 735622 CDM 972 RC 73562 HCPCS facility both 26LT 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 3 Views Left - Report 735622 CDM 972 RC 73562 HCPCS facility both 26LT 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 3 Views Left 735623 CDM 320 RC facility both TCLT 461 461 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 3 Views Left 735623 CDM 320 RC facility both TCLT 461 461 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 3 Views Right 735624 CDM 320 RC facility both TCRT 461 461 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 3 Views Right 735624 CDM 320 RC facility both TCRT 461 461 Gross Charge Type: NIHD_Hosp_Profee_Price 73562 XR Knee 3 Views Right 735625 CDM 320 RC facility both RTTC 461 461 Gross Charge Type: NIHD_Hosp_Profee_Price 73562 XR Knee 3 Views Right 735625 CDM 320 RC facility both RTTC 461 461 Gross Charge Type: NIHD_Hosp_Profee_Price 73562 XR Knee 3 Views Right PROFEE 735626 CDM 972 RC 73562 HCPCS facility both 26RT 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 73562 XR Knee 3 Views Right PROFEE 735626 CDM 972 RC 73562 HCPCS facility both 26RT 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Right - Report 735641 CDM 972 RC 73564 HCPCS facility both 26RT 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Right - Report 735641 CDM 972 RC 73564 HCPCS facility both 26RT 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Left - Report 735642 CDM 972 RC 73564 HCPCS facility both 26LT 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Left - Report 735642 CDM 972 RC 73564 HCPCS facility both 26LT 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Bilateral - Report 735643 CDM 972 RC 73564 HCPCS facility both 2650 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Bilateral - Report 735643 CDM 972 RC 73564 HCPCS facility both 2650 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Bilateral 735644 CDM 320 RC facility both TC 539 539 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Bilateral 735644 CDM 320 RC facility both TC 539 539 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Left 735645 CDM 320 RC facility both TCLT 539 539 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Left 735645 CDM 320 RC facility both TCLT 539 539 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Right 735646 CDM 320 RC facility both TCRT 539 539 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee Complete 4+ Views Right 735646 CDM 320 RC facility both TCRT 539 539 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 View Standing AP Bilateral - Report 735651 CDM 972 RC 73565 HCPCS facility both 2650 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 View Standing AP Bilateral - Report 735651 CDM 972 RC 73565 HCPCS facility both 2650 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 View Standing AP Bilateral 735652 CDM 320 RC facility both TC 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price XR Knee 1 View Standing AP Bilateral 735652 CDM 320 RC facility both TC 377 377 Gross Charge Type: NIHD_Hosp_Profee_Price Lactated Ringers IV Sol 1000 mL [INYO] 73573 CDM J7120 HCPCS 00338-0117-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Lactated Ringers IV Sol 1000 mL [INYO] 73573 CDM J7120 HCPCS 00264-7750-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy XR Arthrogram Knee Left 735801 CDM 322 RC facility both TCLT 1116 1116 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Knee Left 735801 CDM 322 RC facility both TCLT 1116 1116 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Knee Right 735803 CDM 322 RC facility both TCRT 1116 1116 Gross Charge Type: NIHD_Hosp_Profee_Price XR Arthrogram Knee Right 735803 CDM 322 RC facility both TCRT 1116 1116 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Right - Report 735901 CDM 972 RC 73590 HCPCS facility both 26RT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Right - Report 735901 CDM 972 RC 73590 HCPCS facility both 26RT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Left - Report 735902 CDM 972 RC 73590 HCPCS facility both 26LT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Left - Report 735902 CDM 972 RC 73590 HCPCS facility both 26LT 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Bilateral - Report 735903 CDM 972 RC 73590 HCPCS facility both 2650 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Bilateral - Report 735903 CDM 972 RC 73590 HCPCS facility both 2650 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Bilateral 735904 CDM 320 RC facility both TC 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Bilateral 735904 CDM 320 RC facility both TC 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Left 735905 CDM 320 RC facility both TCLT 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Left 735905 CDM 320 RC facility both TCLT 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Right 735906 CDM 320 RC facility both TCRT 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tibia/Fibula Right 735906 CDM 320 RC facility both TCRT 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lower Extremity Infant (0-1yr) Right - Report 735921 CDM 972 RC 73592 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lower Extremity Infant (0-1yr) Right - Report 735921 CDM 972 RC 73592 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lower Extremity Infant (0-1yr) Left - Report 735922 CDM 972 RC 73592 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lower Extremity Infant (0-1yr) Left - Report 735922 CDM 972 RC 73592 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lower Extremity Infant (0-1yr) Left 735923 CDM 320 RC facility both TCLT 241 241 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lower Extremity Infant (0-1yr) Left 735923 CDM 320 RC facility both TCLT 241 241 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lower Extremity Infant (0-1yr) Right 735924 CDM 320 RC facility both TCRT 241 241 Gross Charge Type: NIHD_Hosp_Profee_Price XR Lower Extremity Infant (0-1yr) Right 735924 CDM 320 RC facility both TCRT 241 241 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle 2 Views Left - Report 736001 CDM 972 RC 73600 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle 2 Views Left - Report 736001 CDM 972 RC 73600 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle 2 Views Right - Report 736002 CDM 972 RC 73600 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle 2 Views Right - Report 736002 CDM 972 RC 73600 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle 2 Views Left 736003 CDM 320 RC facility both TCLT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle 2 Views Left 736003 CDM 320 RC facility both TCLT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle 2 Views Right 736004 CDM 320 RC facility both TCRT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle 2 Views Right 736004 CDM 320 RC facility both TCRT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Chloride 0.9% IV Sol 500 mL [INYO] 73601 CDM J7040 HCPCS 00264-7800-10 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 500 mL [INYO] 73601 CDM J7040 HCPCS 00990-7983-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 500 mL [INYO] 73601 CDM J7040 HCPCS 00409-7983-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 500 mL [INYO] 73601 CDM J7040 HCPCS 00338-0049-03 NDC facility both 500 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 250 mL [INYO] 73602 CDM J7040 HCPCS 00264-7800-20 NDC facility both 250 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 250 mL [INYO] 73602 CDM J7040 HCPCS 00409-7983-02 NDC facility both 250 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 250 mL [INYO] 73602 CDM J7040 HCPCS 00338-0049-02 NDC facility both 250 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.45% IV Sol 50 mL [INYO] 73603 CDM 00409-7730-36 NDC facility both 50 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.45% IV Sol 50 mL [INYO] 73603 CDM 00409-7132-66 NDC facility both 50 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.45% IV Sol 100 mL [INYO] 73604 CDM 00409-7730-37 NDC facility both 100 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.45% IV Sol 100 mL [INYO] 73604 CDM 00409-7132-67 NDC facility both 100 ML 275 275 Gross Charge Type: Pharmacy XR Ankle Complete 3+ Views Left - Report 736101 CDM 972 RC 73610 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle Complete 3+ Views Left - Report 736101 CDM 972 RC 73610 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle Complete 3+ Views Right - Report 736102 CDM 972 RC 73610 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle Complete 3+ Views Right - Report 736102 CDM 972 RC 73610 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle Complete 3+ Views Left 736103 CDM 320 RC facility both TCLT 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle Complete 3+ Views Left 736103 CDM 320 RC facility both TCLT 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle Complete 3+ Views Right 736104 CDM 320 RC facility both TCRT 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Ankle Complete 3+ Views Right 736104 CDM 320 RC facility both TCRT 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot 2 Views Right - Report 736201 CDM 972 RC 73620 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot 2 Views Right - Report 736201 CDM 972 RC 73620 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot 2 Views Left - Report 736202 CDM 972 RC 73620 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot 2 Views Left - Report 736202 CDM 972 RC 73620 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot 2 Views Left 736203 CDM 320 RC facility both TCLT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot 2 Views Left 736203 CDM 320 RC facility both TCLT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot 2 Views Right 736204 CDM 320 RC facility both TCRT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot 2 Views Right 736204 CDM 320 RC facility both TCRT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price 73620 XR Foot 2 Views RT 736205 CDM 320 RC facility both TCLT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price 73620 XR Foot 2 Views RT 736205 CDM 320 RC facility both TCLT 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price 73620 XR Foot 2 Views PROFEE 736206 CDM 972 RC 73620 HCPCS facility both LT26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price 73620 XR Foot 2 Views PROFEE 736206 CDM 972 RC 73620 HCPCS facility both LT26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Right - Report 736301 CDM 972 RC 73630 HCPCS facility both 26RT 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Right - Report 736301 CDM 972 RC 73630 HCPCS facility both 26RT 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Left - Report 736302 CDM 972 RC 73630 HCPCS facility both 26LT 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Left - Report 736302 CDM 972 RC 73630 HCPCS facility both 26LT 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Bilateral - Report 736303 CDM 972 RC 73630 HCPCS facility both 2650 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Bilateral - Report 736303 CDM 972 RC 73630 HCPCS facility both 2650 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Bilateral 736304 CDM 320 RC facility both TC 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Bilateral 736304 CDM 320 RC facility both TC 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Left 736305 CDM 320 RC facility both TCLT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Left 736305 CDM 320 RC facility both TCLT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Right 736306 CDM 320 RC facility both TCRT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foot Complete 3+ Views Right 736306 CDM 320 RC facility both TCRT 424 424 Gross Charge Type: NIHD_Hosp_Profee_Price 73630 XR Foot Complete 3+ Views Left 736307 CDM 320 RC facility both TCLT 405 405 Gross Charge Type: NIHD_Hosp_Profee_Price 73630 XR Foot Complete 3+ Views Left 736307 CDM 320 RC facility both TCLT 405 405 Gross Charge Type: NIHD_Hosp_Profee_Price 73630 XR Foot Complete 3+ Views PROFEE 736308 CDM 972 RC 73630 HCPCS facility both 26LT 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price 73630 XR Foot Complete 3+ Views PROFEE 736308 CDM 972 RC 73630 HCPCS facility both 26LT 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price sterile water Irr Sol 1000 mL [INYO] 73645 CDM A4217 HCPCS 00409-7139-09 NDC facility both 1000 ML 37.8 37.8 Gross Charge Type: Pharmacy XR Calcaneus Left - Report 736501 CDM 972 RC 73650 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Calcaneus Left - Report 736501 CDM 972 RC 73650 HCPCS facility both 26LT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Calcaneus Right - Report 736502 CDM 972 RC 73650 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Calcaneus Right - Report 736502 CDM 972 RC 73650 HCPCS facility both 26RT 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Calcaneus Left 736503 CDM 320 RC facility both TCLT 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Calcaneus Left 736503 CDM 320 RC facility both TCLT 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Calcaneus Right 736504 CDM 320 RC facility both TCRT 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price XR Calcaneus Right 736504 CDM 320 RC facility both TCRT 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price sodium chloride 0.9% Irr Sol 1000 mL [INYO] 73657 CDM 00409-7138-09 NDC facility both 1000 ML 37.8 37.8 Gross Charge Type: Pharmacy Amino Acids 8.5% (Aminosyn) IV Sol 500 mL [INYO] 73658 CDM 00409-4187-03 NDC facility both 500 ML 330 330 Gross Charge Type: Pharmacy XR Toe(s) 2+ Views Left - Report 736601 CDM 972 RC 73660 HCPCS facility both 26LT 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Left - Report 736601 CDM 972 RC 73660 HCPCS facility both 26LT 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Left 736602 CDM 320 RC facility both TCLT 314 314 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Left 736602 CDM 320 RC facility both TCLT 314 314 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Right 736603 CDM 320 RC facility both TCRT 314 314 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Right 736603 CDM 320 RC facility both TCRT 314 314 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Right - Report 736604 CDM 972 RC 73660 HCPCS facility both 26RT 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Right - Report 736604 CDM 972 RC 73660 HCPCS facility both 26RT 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Bilat 736605 CDM 320 RC facility both TC 314 314 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Bilat 736605 CDM 320 RC facility both TC 314 314 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Bilat - Report 736606 CDM 972 RC 73660 HCPCS facility both 2650 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price XR Toe(s) 2+ Views Bilat - Report 736606 CDM 972 RC 73660 HCPCS facility both 2650 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price CT Mako Knee w/o Contrast Left - Report 737001_1 CDM 972 RC 73700 HCPCS facility both 26LT 189 189 Gross Charge Type: NIHD_Hosp_Profee_Price CT Mako Knee w/o Contrast Left - Report 737001_1 CDM 972 RC 73700 HCPCS facility both 26LT 189 189 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/o Contrast Left - Report 737001_2 CDM 972 RC 73700 HCPCS facility both 26LT 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/o Contrast Left - Report 737001_2 CDM 972 RC 73700 HCPCS facility both 26LT 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/o Contrast Right - Report 737002 CDM 972 RC 73700 HCPCS facility both 26RT 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/o Contrast Right - Report 737002 CDM 972 RC 73700 HCPCS facility both 26RT 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/o Contrast Left 737003 CDM 352 RC facility both TCLT 2514 2514 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/o Contrast Left 737003 CDM 352 RC facility both TCLT 2514 2514 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/o Contrast Right 737004 CDM 352 RC facility both TCRT 2514 2514 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/o Contrast Right 737004 CDM 352 RC facility both TCRT 2514 2514 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/ Contrast Left - Report 737011 CDM 972 RC 73701 HCPCS facility both 26LT 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/ Contrast Left - Report 737011 CDM 972 RC 73701 HCPCS facility both 26LT 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/ Contrast Right - Report 737012 CDM 972 RC 73701 HCPCS facility both 26RT 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/ Contrast Right - Report 737012 CDM 972 RC 73701 HCPCS facility both 26RT 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/ Contrast Left 737013 CDM 352 RC facility both TCLT 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/ Contrast Left 737013 CDM 352 RC facility both TCLT 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/ Contrast Right 737014 CDM 352 RC facility both TCRT 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/ Contrast Right 737014 CDM 352 RC facility both TCRT 2786 2786 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/+w/o Contrast Left - Report 737021 CDM 972 RC 73702 HCPCS facility both 26LT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/+w/o Contrast Left - Report 737021 CDM 972 RC 73702 HCPCS facility both 26LT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/+w/o Contrast Right - Report 737022 CDM 972 RC 73702 HCPCS facility both 26RT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/+w/o Contrast Right - Report 737022 CDM 972 RC 73702 HCPCS facility both 26RT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/+w/o Contrast Left 737023 CDM 350 RC facility both TCLT 2621 2621 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/+w/o Contrast Left 737023 CDM 350 RC facility both TCLT 2621 2621 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/+w/o Contrast Right 737024 CDM 350 RC facility both TCRT 2621 2621 Gross Charge Type: NIHD_Hosp_Profee_Price CT Lower Extremity w/+w/o Contrast Right 737024 CDM 350 RC facility both TCRT 2621 2621 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Bilateral 73706 CDM 352 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Bilateral 73706 CDM 352 RC facility both TC 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Left - Report 737061 CDM 972 RC 73706 HCPCS facility both 26LT 949 949 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Left - Report 737061 CDM 972 RC 73706 HCPCS facility both 26LT 949 949 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Right - Report 737062 CDM 972 RC 73706 HCPCS facility both 26RT 949 949 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Right - Report 737062 CDM 972 RC 73706 HCPCS facility both 26RT 949 949 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Left 737063 CDM 352 RC facility both TCLT 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Left 737063 CDM 352 RC facility both TCLT 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Right 737064 CDM 352 RC facility both TCRT 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Lower Extremity Right 737064 CDM 352 RC facility both TCRT 3321 3321 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/o Contrast Left 737181 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/o Contrast Left 737181 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/o Contrast Rt - Report 7371810 CDM 972 RC 73718 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/o Contrast Rt - Report 7371810 CDM 972 RC 73718 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/o Contrast Lt 7371811 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/o Contrast Lt 7371811 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/o Contrast Rt 7371812 CDM 610 RC facility both TCRT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/o Contrast Rt 7371812 CDM 610 RC facility both TCRT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/o Contrast Left 7371813 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/o Contrast Left 7371813 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/o Contrast Left - Report 7371814 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/o Contrast Left - Report 7371814 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/o Contrast Right 7371815 CDM 610 RC facility both TCRT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/o Contrast Right 7371815 CDM 610 RC facility both TCRT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/o Contrast Right - Report 7371816 CDM 972 RC 73718 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/o Contrast Right - Report 7371816 CDM 972 RC 73718 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price 73718 MRI Foot w/o Contrast Left 7371817 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price 73718 MRI Foot w/o Contrast Left 7371817 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price 73718 MRI Foot w/o Contrast Left PROFEE 7371818 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price 73718 MRI Foot w/o Contrast Left PROFEE 7371818 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/o Contrast Left - Report 737182 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/o Contrast Left - Report 737182 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/o Contrast Right 737183 CDM 610 RC facility both TCRT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/o Contrast Right 737183 CDM 610 RC facility both TCRT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/o Contrast Right - Report 737184 CDM 972 RC 73718 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/o Contrast Right - Report 737184 CDM 972 RC 73718 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/o Contrast Left - Report 737185 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/o Contrast Left - Report 737185 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/o Contrast Right - Report 737186 CDM 972 RC 73718 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/o Contrast Right - Report 737186 CDM 972 RC 73718 HCPCS facility both 26RT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/o Contrast Left 737187 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/o Contrast Left 737187 CDM 610 RC facility both TCLT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/o Contrast Right 737188 CDM 610 RC facility both TCRT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/o Contrast Right 737188 CDM 610 RC facility both TCRT 3205 3205 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/o Contrast Lt - Report 737189 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/o Contrast Lt - Report 737189 CDM 972 RC 73718 HCPCS facility both 26LT 745 745 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ Contrast Left 737191 CDM 610 RC facility both TCLT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ Contrast Left 737191 CDM 610 RC facility both TCLT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ Contrast Lt 7371911 CDM 610 RC facility both TCLT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ Contrast Lt 7371911 CDM 610 RC facility both TCLT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ Contrast Rt 7371912 CDM 610 RC facility both TCRT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ Contrast Rt 7371912 CDM 610 RC facility both TCRT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ Contrast Left 7371913 CDM 610 RC facility both TCLT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ Contrast Left 7371913 CDM 610 RC facility both TCLT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ Contrast Right 7371915 CDM 610 RC facility both TCRT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ Contrast Right 7371915 CDM 610 RC facility both TCRT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ Contrast Right 737193 CDM 610 RC facility both TCRT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ Contrast Right 737193 CDM 610 RC facility both TCRT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ Contrast Left 737197 CDM 610 RC facility both TCLT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ Contrast Left 737197 CDM 610 RC facility both TCLT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ Contrast Right 737198 CDM 610 RC facility both TCRT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ Contrast Right 737198 CDM 610 RC facility both TCRT 3294 3294 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ + w/o Contrast Left 737201 CDM 610 RC facility both TCLT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ + w/o Contrast Left 737201 CDM 610 RC facility both TCLT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ + w/o Contrast Rt - Report 7372010 CDM 972 RC 73720 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ + w/o Contrast Rt - Report 7372010 CDM 972 RC 73720 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ + w/o Contrast Lt 7372011 CDM 610 RC facility both TCLT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ + w/o Contrast Lt 7372011 CDM 610 RC facility both TCLT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ + w/o Contrast Rt 7372012 CDM 610 RC facility both TCRT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ + w/o Contrast Rt 7372012 CDM 610 RC facility both TCRT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ + w/o Contrast Left 7372013 CDM 610 RC facility both TCLT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ + w/o Contrast Left 7372013 CDM 610 RC facility both TCLT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ + w/o Contrast Left - Report 7372014 CDM 972 RC 73720 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ + w/o Contrast Left - Report 7372014 CDM 972 RC 73720 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ + w/o Contrast Right 7372015 CDM 610 RC facility both TCRT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ + w/o Contrast Right 7372015 CDM 610 RC facility both TCRT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ + w/o Contrast Right - Report 7372016 CDM 972 RC 73720 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Tibia/Fibula w/ + w/o Contrast Right - Report 7372016 CDM 972 RC 73720 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ + w/o Contrast Left - Report 737202 CDM 972 RC 73720 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ + w/o Contrast Left - Report 737202 CDM 972 RC 73720 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ + w/o Contrast Right 737203 CDM 610 RC facility both TCRT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ + w/o Contrast Right 737203 CDM 610 RC facility both TCRT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ + w/o Contrast Right - Report 737204 CDM 972 RC 73720 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Femur w/ + w/o Contrast Right - Report 737204 CDM 972 RC 73720 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ + w/o Contrast Left - Report 737205 CDM 972 RC 73720 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ + w/o Contrast Left - Report 737205 CDM 972 RC 73720 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ + w/o Contrast Right - Report 737206 CDM 972 RC 73720 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ + w/o Contrast Right - Report 737206 CDM 972 RC 73720 HCPCS facility both 26RT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ + w/o Contrast Left 737207 CDM 610 RC facility both TCLT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ + w/o Contrast Left 737207 CDM 610 RC facility both TCLT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ + w/o Contrast Right 737208 CDM 610 RC facility both TCRT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Foot w/ + w/o Contrast Right 737208 CDM 610 RC facility both TCRT 4274 4274 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ + w/o Contrast Lt - Report 737209 CDM 972 RC 73720 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI LE Non Joint w/ + w/o Contrast Lt - Report 737209 CDM 972 RC 73720 HCPCS facility both 26LT 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/o Contrast Left - Report 737211 CDM 972 RC 73721 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/o Contrast Left - Report 737211 CDM 972 RC 73721 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Bilateral - Report 7372110 CDM 972 RC 73721 HCPCS facility both 2650 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Bilateral - Report 7372110 CDM 972 RC 73721 HCPCS facility both 2650 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/o Contrast Left - Report 7372111 CDM 972 RC 73721 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/o Contrast Left - Report 7372111 CDM 972 RC 73721 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/o Contrast Right - Report 7372112 CDM 972 RC 73721 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/o Contrast Right - Report 7372112 CDM 972 RC 73721 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/o Contrast Left 7372113 CDM 610 RC facility both TCLT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/o Contrast Left 7372113 CDM 610 RC facility both TCLT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/o Contrast Right 7372114 CDM 610 RC facility both TCRT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/o Contrast Right 7372114 CDM 610 RC facility both TCRT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/o Contrast Right - Report 737212 CDM 972 RC 73721 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/o Contrast Right - Report 737212 CDM 972 RC 73721 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/o Contrast Left 737213 CDM 610 RC facility both TCLT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/o Contrast Left 737213 CDM 610 RC facility both TCLT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/o Contrast Right 737214 CDM 610 RC facility both TCRT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/o Contrast Right 737214 CDM 610 RC facility both TCRT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Left - Report 737215 CDM 972 RC 73721 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Left - Report 737215 CDM 972 RC 73721 HCPCS facility both 26LT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Right - Report 737216 CDM 972 RC 73721 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Right - Report 737216 CDM 972 RC 73721 HCPCS facility both 26RT 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Left 737217 CDM 610 RC facility both TCLT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Left 737217 CDM 610 RC facility both TCLT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Right 737218 CDM 610 RC facility both TCRT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Right 737218 CDM 610 RC facility both TCRT 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Bilateral 737219 CDM 610 RC facility both TC 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/o Contrast Bilateral 737219 CDM 610 RC facility both TC 3279 3279 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle Arthrogram Left 737221 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle Arthrogram Left 737221 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip Arthrogram Left - Report 7372210 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip Arthrogram Left - Report 7372210 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip Arthrogram Right 7372211 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip Arthrogram Right 7372211 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip Arthrogram Right - Report 7372212 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip Arthrogram Right - Report 7372212 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Left - Report 7372213 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Left - Report 7372213 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Right - Report 7372214 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Right - Report 7372214 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Left 7372215 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Left 7372215 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Right 7372216 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Right 7372216 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Bilateral 7372217 CDM 610 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Bilateral 7372217 CDM 610 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Bilateral - Report 7372218 CDM 972 RC 73722 HCPCS facility both 2650 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ Contrast Bilateral - Report 7372218 CDM 972 RC 73722 HCPCS facility both 2650 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee Arthrogram Left 7372219 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee Arthrogram Left 7372219 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle Arthrogram Left - Report 737222 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle Arthrogram Left - Report 737222 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee Arthrogram Left - Report 7372220 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee Arthrogram Left - Report 7372220 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee Arthrogram Right 7372221 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee Arthrogram Right 7372221 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee Arthrogram Right - Report 7372222 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee Arthrogram Right - Report 7372222 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ Contrast Left - Report 7372223 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ Contrast Left - Report 7372223 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ Contrast Right - Report 7372224 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ Contrast Right - Report 7372224 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ Contrast Left 7372225 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ Contrast Left 7372225 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ Contrast Right 7372226 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ Contrast Right 7372226 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle Arthrogram Right 737223 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle Arthrogram Right 737223 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle Arthrogram Right - Report 737224 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle Arthrogram Right - Report 737224 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ Contrast Left - Report 737225 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ Contrast Left - Report 737225 CDM 972 RC 73722 HCPCS facility both 26LT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ Contrast Right - Report 737226 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ Contrast Right - Report 737226 CDM 972 RC 73722 HCPCS facility both 26RT 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ Contrast Left 737227 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ Contrast Left 737227 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ Contrast Right 737228 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ Contrast Right 737228 CDM 610 RC facility both TCRT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip Arthrogram Left 737229 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip Arthrogram Left 737229 CDM 610 RC facility both TCLT 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ + w/o Contrast Left - Report 737231 CDM 972 RC 73723 HCPCS facility both 26LT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ + w/o Contrast Left - Report 737231 CDM 972 RC 73723 HCPCS facility both 26LT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Bilateral - Report 7372310 CDM 972 RC 73723 HCPCS facility both 2650 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Bilateral - Report 7372310 CDM 972 RC 73723 HCPCS facility both 2650 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ + w/o Contrast Left - Report 7372311 CDM 972 RC 73723 HCPCS facility both 26LT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ + w/o Contrast Left - Report 7372311 CDM 972 RC 73723 HCPCS facility both 26LT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ + w/o Contrast Right - Report 7372312 CDM 972 RC 73723 HCPCS facility both 26RT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ + w/o Contrast Right - Report 7372312 CDM 972 RC 73723 HCPCS facility both 26RT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ + w/o Contrast Left 7372313 CDM 610 RC facility both TCLT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ + w/o Contrast Left 7372313 CDM 610 RC facility both TCLT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ + w/o Contrast Right 7372314 CDM 610 RC facility both TCRT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Knee w/ + w/o Contrast Right 7372314 CDM 610 RC facility both TCRT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ + w/o Contrast Right - Report 737232 CDM 972 RC 73723 HCPCS facility both 26RT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ + w/o Contrast Right - Report 737232 CDM 972 RC 73723 HCPCS facility both 26RT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ + w/o Contrast Left 737233 CDM 610 RC facility both TCLT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ + w/o Contrast Left 737233 CDM 610 RC facility both TCLT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ + w/o Contrast Right 737234 CDM 610 RC facility both TCRT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Ankle w/ + w/o Contrast Right 737234 CDM 610 RC facility both TCRT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Left - Report 737235 CDM 972 RC 73723 HCPCS facility both 26LT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Left - Report 737235 CDM 972 RC 73723 HCPCS facility both 26LT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Right - Report 737236 CDM 972 RC 73723 HCPCS facility both 26RT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Right - Report 737236 CDM 972 RC 73723 HCPCS facility both 26RT 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Left 737237 CDM 610 RC facility both TCLT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Left 737237 CDM 610 RC facility both TCLT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Right 737238 CDM 610 RC facility both TCRT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Right 737238 CDM 610 RC facility both TCRT 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Bilateral 737239 CDM 610 RC facility both TC 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Hip w/ + w/o Contrast Bilateral 737239 CDM 610 RC facility both TC 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price SODIUM CHLORIDE 500ML 6138-03 73997 CDM 258 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SODIUM CHLORIDE 500ML 6138-03 73997 CDM 258 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 1 View 740181 CDM 320 RC facility both TC 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 1 View 740181 CDM 320 RC facility both TC 361 361 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 1 View - Report 740182 CDM 972 RC 74018 HCPCS facility both 26 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 1 View - Report 740182 CDM 972 RC 74018 HCPCS facility both 26 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 2 Views 740191 CDM 320 RC facility both TC 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 2 Views 740191 CDM 320 RC facility both TC 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 2 Views - Report 740192 CDM 972 RC 74019 HCPCS facility both 26 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 2 Views - Report 740192 CDM 972 RC 74019 HCPCS facility both 26 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen Complete w Decub and/or Erect - Report 740211 CDM 972 RC 74021 HCPCS facility both 26 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen Complete w Decub and/or Erect - Report 740211 CDM 972 RC 74021 HCPCS facility both 26 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen Complete w Decub and/or Erect 740212 CDM 320 RC facility both TC 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen Complete w Decub and/or Erect 740212 CDM 320 RC facility both TC 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 3+ Views 740213 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 3+ Views 740213 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 3+ Views - Report 740214 CDM 972 RC 74021 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen 3+ Views - Report 740214 CDM 972 RC 74021 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen Series + Chest 1 View - Report 740221 CDM 972 RC 74022 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen Series + Chest 1 View - Report 740221 CDM 972 RC 74022 HCPCS facility both 26 88 88 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen Series + Chest 1 View 740222 CDM 320 RC facility both TC 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price XR Abdomen Series + Chest 1 View 740222 CDM 320 RC facility both TC 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/o Contrast - Report 741502 CDM 972 RC 74150 HCPCS facility both 26 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/o Contrast - Report 741502 CDM 972 RC 74150 HCPCS facility both 26 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/o Contrast 741503 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/o Contrast 741503 CDM 352 RC facility both TC 2650 2650 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/ Contrast - Report 741602 CDM 972 RC 74160 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/ Contrast - Report 741602 CDM 972 RC 74160 HCPCS facility both 26 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/ Contrast 741603 CDM 352 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/ Contrast 741603 CDM 352 RC facility both TC 3048 3048 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/ + w/o Contrast - Report 741702 CDM 972 RC 74170 HCPCS facility both 26 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/ + w/o Contrast - Report 741702 CDM 972 RC 74170 HCPCS facility both 26 553 553 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/ + w/o Contrast 741703 CDM 352 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen w/ + w/o Contrast 741703 CDM 352 RC facility both TC 3582 3582 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen and Pelvis 741742 CDM 350 RC facility both TC 4358 4358 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen and Pelvis 741742 CDM 350 RC facility both TC 4358 4358 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen and Pelvis - Report 741743 CDM 972 RC 74174 HCPCS facility both 26 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen and Pelvis - Report 741743 CDM 972 RC 74174 HCPCS facility both 26 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen - Report 741751 CDM 972 RC 74175 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen - Report 741751 CDM 972 RC 74175 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen 741752 CDM 352 RC facility both TC 3918 3918 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen 741752 CDM 352 RC facility both TC 3918 3918 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/o Contrast 741762 CDM 350 RC facility both TC 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/o Contrast 741762 CDM 350 RC facility both TC 4515 4515 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/o Contrast - Report 741763 CDM 972 RC 74176 HCPCS facility both 26 1260 1260 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/o Contrast - Report 741763 CDM 972 RC 74176 HCPCS facility both 26 1260 1260 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/ Contrast 741772 CDM 350 RC facility both TC 5112 5112 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/ Contrast 741772 CDM 350 RC facility both TC 5112 5112 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/ Contrast - Report 741773 CDM 972 RC 74177 HCPCS facility both 26 1439 1439 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/ Contrast - Report 741773 CDM 972 RC 74177 HCPCS facility both 26 1439 1439 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/ + w/o Contrast 741782 CDM 350 RC facility both TC 5971 5971 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/ + w/o Contrast 741782 CDM 350 RC facility both TC 5971 5971 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/ + w/o Contrast - Report 741783 CDM 972 RC 74178 HCPCS facility both 26 1439 1439 Gross Charge Type: NIHD_Hosp_Profee_Price CT Abdomen and Pelvis w/ + w/o Contrast - Report 741783 CDM 972 RC 74178 HCPCS facility both 26 1439 1439 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/o Contrast - Report 741811 CDM 972 RC 74181 HCPCS facility both 26 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/o Contrast - Report 741811 CDM 972 RC 74181 HCPCS facility both 26 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/o Contrast 741812 CDM 610 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/o Contrast 741812 CDM 610 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price MRI MRCP 741813 CDM 610 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price MRI MRCP 741813 CDM 610 RC facility both TC 3457 3457 Gross Charge Type: NIHD_Hosp_Profee_Price MRI MRCP - Report 741814 CDM 972 RC 74181 HCPCS facility both 26 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price MRI MRCP - Report 741814 CDM 972 RC 74181 HCPCS facility both 26 684 684 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/ Contrast - Report 741821 CDM 972 RC 74182 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/ Contrast - Report 741821 CDM 972 RC 74182 HCPCS facility both 26 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/ Contrast 741822 CDM 610 RC facility both TC 3853 3853 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/ Contrast 741822 CDM 610 RC facility both TC 3853 3853 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/ + w/o Contrast - Report 741831 CDM 972 RC 74183 HCPCS facility both 26 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/ + w/o Contrast - Report 741831 CDM 972 RC 74183 HCPCS facility both 26 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/ + w/o Contrast 741832 CDM 610 RC facility both TC 4714 4714 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Abdomen w/ + w/o Contrast 741832 CDM 610 RC facility both TC 4714 4714 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Abdomen + Runoff w/ + w/o Contrast 741851 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Abdomen + Runoff w/ + w/o Contrast 741851 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Abdomen + Runoff w/ + w/o Contrast - Report 741852 CDM 972 RC 74185 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Abdomen + Runoff w/ + w/o Contrast - Report 741852 CDM 972 RC 74185 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Abdomen + Runoff w/ Contrast 741853 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Abdomen + Runoff w/ Contrast 741853 CDM 320 RC facility both TC 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Abdomen + Runoff w/ Contrast - Report 741854 CDM 972 RC 74185 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price MRA Abdomen + Runoff w/ Contrast - Report 741854 CDM 972 RC 74185 HCPCS facility both 26 469 469 Gross Charge Type: NIHD_Hosp_Profee_Price "Symbotex Composite Mesh, 9 cm" 7420009 CDM 278 RC facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price "Symbotex Composite Mesh, 9 cm" 7420009 CDM 278 RC facility both 963 963 Gross Charge Type: NIHD_Hosp_Profee_Price XR Esophagus - Report 742201 CDM 972 RC 74220 HCPCS facility both 26 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price XR Esophagus - Report 742201 CDM 972 RC 74220 HCPCS facility both 26 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price XR Esophagus 742202 CDM 320 RC facility both TC 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price XR Esophagus 742202 CDM 320 RC facility both TC 676 676 Gross Charge Type: NIHD_Hosp_Profee_Price XR Swallowing Function w/ Speech - Report 742301 CDM 972 RC 74230 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price XR Swallowing Function w/ Speech - Report 742301 CDM 972 RC 74230 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price XR Swallowing Function w/ Speech 742302 CDM 320 RC facility both TC 744 744 Gross Charge Type: NIHD_Hosp_Profee_Price XR Swallowing Function w/ Speech 742302 CDM 320 RC facility both TC 744 744 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI - Report 742401 CDM 972 RC 74240 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI - Report 742401 CDM 972 RC 74240 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI 742402 CDM 320 RC facility both TC 854 854 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI 742402 CDM 320 RC facility both TC 854 854 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air Contrast - Report 742461 CDM 972 RC 74246 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air Contrast - Report 742461 CDM 972 RC 74246 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air Contrast + KUB - Report 742462 CDM 972 RC 74246 HCPCS facility both 26 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air Contrast + KUB - Report 742462 CDM 972 RC 74246 HCPCS facility both 26 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air w/ Small Bowel - Report 742463 CDM 972 RC 74246 HCPCS facility both 26 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air w/ Small Bowel - Report 742463 CDM 972 RC 74246 HCPCS facility both 26 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air Contrast 742464 CDM 320 RC facility both TC 906 906 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air Contrast 742464 CDM 320 RC facility both TC 906 906 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air Contrast + KUB 742465 CDM 320 RC facility both TC 906 906 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air Contrast + KUB 742465 CDM 320 RC facility both TC 906 906 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air w/ Small Bowel 742466 CDM 320 RC facility both TC 906 906 Gross Charge Type: NIHD_Hosp_Profee_Price XR Upper GI w/ Air w/ Small Bowel 742466 CDM 320 RC facility both TC 906 906 Gross Charge Type: NIHD_Hosp_Profee_Price XR Small Bowel w/ Multiple Series - Report 742501 CDM 972 RC 74250 HCPCS facility both 26 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price XR Small Bowel w/ Multiple Series - Report 742501 CDM 972 RC 74250 HCPCS facility both 26 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price XR Small Bowel w/ Multiple Series 742502 CDM 320 RC facility both TCLT 822 822 Gross Charge Type: NIHD_Hosp_Profee_Price XR Small Bowel w/ Multiple Series 742502 CDM 320 RC facility both TCLT 822 822 Gross Charge Type: NIHD_Hosp_Profee_Price XR Barium Enema Complete - Report 742701 CDM 972 RC 74270 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price XR Barium Enema Complete - Report 742701 CDM 972 RC 74270 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price XR Barium Enema Complete 742702 CDM 320 RC facility both TC 948 948 Gross Charge Type: NIHD_Hosp_Profee_Price XR Barium Enema Complete 742702 CDM 320 RC facility both TC 948 948 Gross Charge Type: NIHD_Hosp_Profee_Price XR Barium Enema w/ Air Complete - Report 742801 CDM 972 RC 74280 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price XR Barium Enema w/ Air Complete - Report 742801 CDM 972 RC 74280 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price XR Barium Enema w/ Air Complete 742802 CDM 320 RC facility both TC 1210 1210 Gross Charge Type: NIHD_Hosp_Profee_Price XR Barium Enema w/ Air Complete 742802 CDM 320 RC facility both TC 1210 1210 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cholangiogram in OR - Report 743001 CDM 972 RC 74300 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cholangiogram in OR - Report 743001 CDM 972 RC 74300 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cholangiogram in OR 743002 CDM 320 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cholangiogram in OR 743002 CDM 320 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price XR IVP w/ Tomography 744151 CDM 320 RC facility both TC 1299 1299 Gross Charge Type: NIHD_Hosp_Profee_Price XR IVP w/ Tomography 744151 CDM 320 RC facility both TC 1299 1299 Gross Charge Type: NIHD_Hosp_Profee_Price XR IVP w/ Tomography - Report 744152 CDM 972 RC 74415 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price XR IVP w/ Tomography - Report 744152 CDM 972 RC 74415 HCPCS facility both 26 385 385 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urography Retrograde 744201 CDM 320 RC facility both TC 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urography Retrograde 744201 CDM 320 RC facility both TC 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urography Retrograde - Report 744202 CDM 972 RC 74420 HCPCS facility both 26 294 294 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urography Retrograde - Report 744202 CDM 972 RC 74420 HCPCS facility both 26 294 294 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urography Antegrade 744251 CDM 320 RC facility both TC 944 944 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urography Antegrade 744251 CDM 320 RC facility both TC 944 944 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urography Antegrade - Report 744252 CDM 972 RC 74425 HCPCS facility both 26 224 224 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urography Antegrade - Report 744252 CDM 972 RC 74425 HCPCS facility both 26 224 224 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephrostogram Right 7442523 CDM 320 RC facility both TC 944 944 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephrostogram Right 7442523 CDM 320 RC facility both TC 944 944 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephrostogram Right - Report 744254 CDM 972 RC 74425 HCPCS facility both 26 224 224 Gross Charge Type: NIHD_Hosp_Profee_Price XR Nephrostogram Right - Report 744254 CDM 972 RC 74425 HCPCS facility both 26 224 224 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cystogram - Report 744301 CDM 972 RC 74430 HCPCS facility both 26 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cystogram - Report 744301 CDM 972 RC 74430 HCPCS facility both 26 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cystogram 744302 CDM 320 RC facility both TC 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price XR Cystogram 744302 CDM 320 RC facility both TC 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urethrocystography Retrograde 744502 CDM 320 RC facility both TC 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price XR Urethrocystography Retrograde 744502 CDM 320 RC facility both TC 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price XR Voiding Urethrocystography - Report 744551 CDM 972 RC 74455 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Voiding Urethrocystography - Report 744551 CDM 972 RC 74455 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Voiding Urethrocystography 744552 CDM 320 RC facility both TC 922 922 Gross Charge Type: NIHD_Hosp_Profee_Price XR Voiding Urethrocystography 744552 CDM 320 RC facility both TC 922 922 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hysterosalpingography - Report 747401 CDM 972 RC 74740 HCPCS facility both 26 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hysterosalpingography - Report 747401 CDM 972 RC 74740 HCPCS facility both 26 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hysterosalpingography 747402 CDM 320 RC facility both TC 948 948 Gross Charge Type: NIHD_Hosp_Profee_Price XR Hysterosalpingography 747402 CDM 320 RC facility both TC 948 948 Gross Charge Type: NIHD_Hosp_Profee_Price CT Heart Calcium Scoring 755711 CDM 350 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price CT Heart Calcium Scoring 755711 CDM 350 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price CT Heart Calcium Scoring - Report 755712 CDM 972 RC 75571 HCPCS facility both 26 194 194 Gross Charge Type: NIHD_Hosp_Profee_Price CT Heart Calcium Scoring - Report 755712 CDM 972 RC 75571 HCPCS facility both 26 194 194 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Coronary Artery w/ Ca Score 755741 CDM 350 RC facility both TC 2317 2317 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Coronary Artery w/ Ca Score 755741 CDM 350 RC facility both TC 2317 2317 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Coronary Artery w/ Ca Score - Report 755742 CDM 75574 HCPCS facility both 26 535 535 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Coronary Artery w/ Ca Score - Report 755742 CDM 75574 HCPCS facility both 26 535 535 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Heart/Coronary Arteries 755743 CDM 350 RC facility both TC 2317 2317 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Heart/Coronary Arteries 755743 CDM 350 RC facility both TC 2317 2317 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Heart/Coronary Arteries - Report 755744 CDM 75574 HCPCS facility both 26 535 535 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Heart/Coronary Arteries - Report 755744 CDM 75574 HCPCS facility both 26 535 535 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen Aorta + Iliofemoral - Report 756351 CDM 972 RC 75635 HCPCS facility both 26 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen Aorta + Iliofemoral - Report 756351 CDM 972 RC 75635 HCPCS facility both 26 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen Aorta + Iliofemoral 756352 CDM 350 RC facility both TC 4578 4578 Gross Charge Type: NIHD_Hosp_Profee_Price CT Angio Abdomen Aorta + Iliofemoral 756352 CDM 350 RC facility both TC 4578 4578 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD I-123 IOBENGUANE DX PER STUDY DOSE 7578634 CDM 343 RC facility both TC 13141 13141 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD I-123 IOBENGUANE DX PER STUDY DOSE 7578634 CDM 343 RC facility both TC 13141 13141 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shuntogram Non-Vascular SI - Report 758091 CDM 982 RC 75809 HCPCS facility both 26 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shuntogram Non-Vascular SI - Report 758091 CDM 982 RC 75809 HCPCS facility both 26 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shuntogram Non-Vascular SI 758092 CDM 320 RC facility both TC 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price XR Shuntogram Non-Vascular SI 758092 CDM 320 RC facility both TC 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price CT Venogram Extremity Left 758201 CDM 320 RC facility both TCLT 1908 1908 Gross Charge Type: NIHD_Hosp_Profee_Price CT Venogram Extremity Left 758201 CDM 320 RC facility both TCLT 1908 1908 Gross Charge Type: NIHD_Hosp_Profee_Price CT Venogram Extremity Right 758203 CDM 320 RC facility both TCRT 1908 1908 Gross Charge Type: NIHD_Hosp_Profee_Price CT Venogram Extremity Right 758203 CDM 320 RC facility both TCRT 1908 1908 Gross Charge Type: NIHD_Hosp_Profee_Price CT Venogram Exremity Bilateral 758221 CDM 320 RC facility both TC 2394 2394 Gross Charge Type: NIHD_Hosp_Profee_Price CT Venogram Exremity Bilateral 758221 CDM 320 RC facility both TC 2394 2394 Gross Charge Type: NIHD_Hosp_Profee_Price CT Venogram Exremity Bilateral - Report 758222 CDM 972 RC 75822 HCPCS facility both 2650 418 418 Gross Charge Type: NIHD_Hosp_Profee_Price CT Venogram Exremity Bilateral - Report 758222 CDM 972 RC 75822 HCPCS facility both 2650 418 418 Gross Charge Type: NIHD_Hosp_Profee_Price XR Fluoroscopy Under 1 Hour 760001 CDM 320 RC facility both TC 723 723 Gross Charge Type: NIHD_Hosp_Profee_Price XR Fluoroscopy Under 1 Hour 760001 CDM 320 RC facility both TC 723 723 Gross Charge Type: NIHD_Hosp_Profee_Price XR Fluoroscopy Under 1 Hour - Report 760002 CDM 972 RC 76000 HCPCS facility both 26 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Fluoroscopy Under 1 Hour - Report 760002 CDM 972 RC 76000 HCPCS facility both 26 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foreign Body Localization Child 1 Vw - Report 760101 CDM 972 RC 76010 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foreign Body Localization Child 1 Vw - Report 760101 CDM 972 RC 76010 HCPCS facility both 26 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foreign Body Localization Child 1 Vw 760102 CDM 320 RC facility both TC 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price XR Foreign Body Localization Child 1 Vw 760102 CDM 320 RC facility both TC 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Tissue Specimen 760981 CDM 320 RC facility both TC 759 759 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Tissue Specimen 760981 CDM 320 RC facility both TC 759 759 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Tissue Specimen - Report 760982 CDM 972 RC 76098 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Breast Tissue Specimen - Report 760982 CDM 972 RC 76098 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tomography Single Plane - Report 761001 CDM 972 RC 76100 HCPCS facility both 26 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tomography Single Plane - Report 761001 CDM 972 RC 76100 HCPCS facility both 26 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tomography Single Plane 761002 CDM 320 RC facility both TC 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price XR Tomography Single Plane 761002 CDM 320 RC facility both TC 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price Blepharoplasty 7632799 CDM 360 RC facility both 16764 16764 Gross Charge Type: NIHD_Hosp_Profee_Price Blepharoplasty 7632799 CDM 360 RC facility both 16764 16764 Gross Charge Type: NIHD_Hosp_Profee_Price Bronchoscopy 7632839 CDM 360 RC facility both 4553 4553 Gross Charge Type: NIHD_Hosp_Profee_Price Bronchoscopy 7632839 CDM 360 RC facility both 4553 4553 Gross Charge Type: NIHD_Hosp_Profee_Price Colonoscopy 7632975 CDM 360 RC facility both 3669 3669 Gross Charge Type: NIHD_Hosp_Profee_Price Colonoscopy 7632975 CDM 360 RC facility both 3669 3669 Gross Charge Type: NIHD_Hosp_Profee_Price Colonoscopy Biopsy 7632976 CDM 360 RC facility both 4406 4406 Gross Charge Type: NIHD_Hosp_Profee_Price Colonoscopy Biopsy 7632976 CDM 360 RC facility both 4406 4406 Gross Charge Type: NIHD_Hosp_Profee_Price Cryotherapy Eye 7633062 CDM 360 RC facility both 12973 12973 Gross Charge Type: NIHD_Hosp_Profee_Price Cryotherapy Eye 7633062 CDM 360 RC facility both 12973 12973 Gross Charge Type: NIHD_Hosp_Profee_Price Enucleation Eye 7633289 CDM 360 RC facility both 9580 9580 Gross Charge Type: NIHD_Hosp_Profee_Price Enucleation Eye 7633289 CDM 360 RC facility both 9580 9580 Gross Charge Type: NIHD_Hosp_Profee_Price Esophagogastroduodenoscopy 7633302 CDM 360 RC facility both 3519 3519 Gross Charge Type: NIHD_Hosp_Profee_Price Esophagogastroduodenoscopy 7633302 CDM 360 RC facility both 3519 3519 Gross Charge Type: NIHD_Hosp_Profee_Price Esophagogastroduodenoscopy Biopsy 7633304 CDM 360 RC facility both 4667 4667 Gross Charge Type: NIHD_Hosp_Profee_Price Esophagogastroduodenoscopy Biopsy 7633304 CDM 360 RC facility both 4667 4667 Gross Charge Type: NIHD_Hosp_Profee_Price Esophagogastroduodenoscopy Foreign Body Removal 7633308 CDM 360 RC facility both 4667 4667 Gross Charge Type: NIHD_Hosp_Profee_Price Esophagogastroduodenoscopy Foreign Body Removal 7633308 CDM 360 RC facility both 4667 4667 Gross Charge Type: NIHD_Hosp_Profee_Price Esophagogastroduodenoscopy Guided Dilatation 7633310 CDM 360 RC facility both 4667 4667 Gross Charge Type: NIHD_Hosp_Profee_Price Esophagogastroduodenoscopy Guided Dilatation 7633310 CDM 360 RC facility both 4667 4667 Gross Charge Type: NIHD_Hosp_Profee_Price Exchange Intraocular Lens 7633347 CDM 360 RC facility both 9443 9443 Gross Charge Type: NIHD_Hosp_Profee_Price Exchange Intraocular Lens 7633347 CDM 360 RC facility both 9443 9443 Gross Charge Type: NIHD_Hosp_Profee_Price Excision Lesion Eyelid 7633490 CDM 360 RC facility both 6946 6946 Gross Charge Type: NIHD_Hosp_Profee_Price Excision Lesion Eyelid 7633490 CDM 360 RC facility both 6946 6946 Gross Charge Type: NIHD_Hosp_Profee_Price Exploration Ruptured Globe 7633578 CDM 360 RC facility both 10407 10407 Gross Charge Type: NIHD_Hosp_Profee_Price Exploration Ruptured Globe 7633578 CDM 360 RC facility both 10407 10407 Gross Charge Type: NIHD_Hosp_Profee_Price Extraction Cataract with Intraocular Lens Insertion 7633598 CDM 360 RC facility both 3418 3418 Gross Charge Type: NIHD_Hosp_Profee_Price Extraction Cataract with Intraocular Lens Insertion 7633598 CDM 360 RC facility both 3418 3418 Gross Charge Type: NIHD_Hosp_Profee_Price Loop Electrode Excision Procedure 7633995 CDM 360 RC facility both 3643 3643 Gross Charge Type: NIHD_Hosp_Profee_Price Loop Electrode Excision Procedure 7633995 CDM 360 RC facility both 3643 3643 Gross Charge Type: NIHD_Hosp_Profee_Price Probing Lacrimal Structure 7634215 CDM 360 RC facility both 6175 6175 Gross Charge Type: NIHD_Hosp_Profee_Price Probing Lacrimal Structure 7634215 CDM 360 RC facility both 6175 6175 Gross Charge Type: NIHD_Hosp_Profee_Price Repair Ectropion 7634399 CDM 360 RC facility both 7083 7083 Gross Charge Type: NIHD_Hosp_Profee_Price Repair Ectropion 7634399 CDM 360 RC facility both 7083 7083 Gross Charge Type: NIHD_Hosp_Profee_Price Trabeculectomy 7634708 CDM 360 RC facility both 10367 10367 Gross Charge Type: NIHD_Hosp_Profee_Price Trabeculectomy 7634708 CDM 360 RC facility both 10367 10367 Gross Charge Type: NIHD_Hosp_Profee_Price 76376 PRMH CT 3D Rendering Rad Charge 76376 CDM 320 RC facility both TC 941 941 Gross Charge Type: NIHD_Hosp_Profee_Price 76376 PRMH CT 3D Rendering Rad Charge 76376 CDM 320 RC facility both TC 941 941 Gross Charge Type: NIHD_Hosp_Profee_Price 76376 3D RNDR I&R CT MRI US/OTH X REQ POSTPCX ProFee 763761 CDM 972 RC 76376 HCPCS facility both 26 38 38 Gross Charge Type: NIHD_Hosp_Profee_Price 76376 3D RNDR I&R CT MRI US/OTH X REQ POSTPCX ProFee 763761 CDM 972 RC 76376 HCPCS facility both 26 38 38 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD CT 3D RECONSTRUCTION 76377 CDM 350 RC facility both TC 834 834 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD CT 3D RECONSTRUCTION 76377 CDM 350 RC facility both TC 834 834 Gross Charge Type: NIHD_Hosp_Profee_Price 76512 OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN Tech Fee 76512 CDM 402 RC facility both TC 511 511 Gross Charge Type: NIHD_Hosp_Profee_Price 76512 OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN Tech Fee 76512 CDM 402 RC facility both TC 511 511 Gross Charge Type: NIHD_Hosp_Profee_Price 76512 OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN 765121 CDM 982 RC 76512 HCPCS facility both 26 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price 76512 OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN 765121 CDM 982 RC 76512 HCPCS facility both 26 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price US Head/Neck Soft Tissue - Report 765361 CDM 972 RC 76536 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Head/Neck Soft Tissue - Report 765361 CDM 972 RC 76536 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Head/Neck Soft Tissue 765362 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Head/Neck Soft Tissue 765362 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Thyroid 765363 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Thyroid 765363 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Thyroid - Report 765364 CDM 972 RC 76536 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Thyroid - Report 765364 CDM 972 RC 76536 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price 76536 US Soft Tissues Head / Neck 765365 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 76536 US Soft Tissues Head / Neck 765365 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM ProFee 765366 CDM 972 RC 76536 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price 76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM ProFee 765366 CDM 972 RC 76536 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Buttocks or Pelvic Wall 765879 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Buttocks or Pelvic Wall 765879 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price 76604 POCUS Chest TechFee 76604 CDM 402 RC facility both 864 864 Gross Charge Type: NIHD_Hosp_Profee_Price 76604 POCUS Chest TechFee 76604 CDM 402 RC facility both 864 864 Gross Charge Type: NIHD_Hosp_Profee_Price 76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION 766041 CDM 982 RC 76604 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price 76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION 766041 CDM 982 RC 76604 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price US Chest 766042 CDM 402 RC facility both TC 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price US Chest 766042 CDM 402 RC facility both TC 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price US Chest - Report 766043 CDM 972 RC 76604 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price US Chest - Report 766043 CDM 972 RC 76604 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Chest or Upper Back 766044 CDM 402 RC facility both TC 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Chest or Upper Back 766044 CDM 402 RC facility both TC 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Chest or Upper Back - Report 766045 CDM 972 RC 76604 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Chest or Upper Back - Report 766045 CDM 972 RC 76604 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Left. 766411 CDM 402 RC facility both TCLT 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Left. 766411 CDM 402 RC facility both TCLT 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Left. - Report 766412 CDM 972 RC 76641 HCPCS facility both 26LT 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Left. - Report 766412 CDM 972 RC 76641 HCPCS facility both 26LT 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Right. 766413 CDM 402 RC facility both TCRT 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Right. 766413 CDM 402 RC facility both TCRT 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Right. - Report 766414 CDM 972 RC 76641 HCPCS facility both 26RT 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Right. - Report 766414 CDM 972 RC 76641 HCPCS facility both 26RT 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Bilat. 766415 CDM 402 RC facility both TC 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Bilat. 766415 CDM 402 RC facility both TC 534 534 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Bilat. - Report 766416 CDM 972 RC 76641 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price US Breast Complete Bilat. - Report 766416 CDM 972 RC 76641 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price 76642 ULTRASOUND BREAST LIMITED 76642 CDM 982 RC 76642 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 76642 ULTRASOUND BREAST LIMITED 76642 CDM 982 RC 76642 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 76700 US Abdomen Complete PROFEE 76700 CDM 972 RC 76700 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price 76700 US Abdomen Complete PROFEE 76700 CDM 972 RC 76700 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price US Abdomen Complete - Report 767001 CDM 972 RC 76700 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price US Abdomen Complete - Report 767001 CDM 972 RC 76700 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price US Abdomen Complete 767002 CDM 402 RC facility both TC 1247 1247 Gross Charge Type: NIHD_Hosp_Profee_Price US Abdomen Complete 767002 CDM 402 RC facility both TC 1247 1247 Gross Charge Type: NIHD_Hosp_Profee_Price 76705 POCUS Abdomen Limited TechFee 76705 CDM 402 RC facility both TC 1033 1033 Gross Charge Type: NIHD_Hosp_Profee_Price 76705 POCUS Abdomen Limited TechFee 76705 CDM 402 RC facility both TC 1033 1033 Gross Charge Type: NIHD_Hosp_Profee_Price 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED 767051 CDM 982 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED 767051 CDM 982 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Abd/Pel 7670510 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Abd/Pel 7670510 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Abd/Pel - Report 7670511 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Abd/Pel - Report 7670511 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Abdomen Limited - Report 767052 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Abdomen Limited - Report 767052 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Abdomen Limited 767053 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Abdomen Limited 767053 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US APPENDIX 767054 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US APPENDIX 767054 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Appendix - Report 767055 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Appendix - Report 767055 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Gallbladder 767056 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Gallbladder 767056 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Gallbladder - Report 767057 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Gallbladder - Report 767057 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Pyloris 767058 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Pyloris 767058 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Pyloris - Report 767059 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Pyloris - Report 767059 CDM 972 RC 76705 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Renal Artery Duplex Bilateral 76770_402 CDM 402 RC facility both TC 1173 1173 Gross Charge Type: NIHD_Hosp_Profee_Price US Renal Artery Duplex Bilateral 76770_402 CDM 402 RC facility both TC 1173 1173 Gross Charge Type: NIHD_Hosp_Profee_Price US Renal Artery Duplex Bilateral - Report 76770_972 CDM 972 RC 76770 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Renal Artery Duplex Bilateral - Report 76770_972 CDM 972 RC 76770 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Retroperitoneal Complete - Report 767701 CDM 972 RC 76770 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Retroperitoneal Complete - Report 767701 CDM 972 RC 76770 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Retroperitoneal Complete 767702 CDM 402 RC facility both TC 1173 1173 Gross Charge Type: NIHD_Hosp_Profee_Price US Retroperitoneal Complete 767702 CDM 402 RC facility both TC 1173 1173 Gross Charge Type: NIHD_Hosp_Profee_Price 76770 US RETROPERITONEAL CMPL 767704 CDM 402 RC facility both TC 1173 1173 Gross Charge Type: NIHD_Hosp_Profee_Price 76770 US RETROPERITONEAL CMPL 767704 CDM 402 RC facility both TC 1173 1173 Gross Charge Type: NIHD_Hosp_Profee_Price 76770 US RETROPERITONEAL CMPL:PROF 767705 CDM 972 RC 76770 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price 76770 US RETROPERITONEAL CMPL:PROF 767705 CDM 972 RC 76770 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price 76775 POCUS Aorta Limited TechFee 76775 CDM 402 RC facility both 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price 76775 POCUS Aorta Limited TechFee 76775 CDM 402 RC facility both 960 960 Gross Charge Type: NIHD_Hosp_Profee_Price 76775 US RETROPERITONEAL REAL TIME W/IMAGE LIMITED 767751 CDM 982 RC 76775 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 76775 US RETROPERITONEAL REAL TIME W/IMAGE LIMITED 767751 CDM 982 RC 76775 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Retroperitoneal Limited - Report 767752 CDM 972 RC 76775 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Retroperitoneal Limited - Report 767752 CDM 972 RC 76775 HCPCS facility both 26 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price US Retroperitoneal Limited 767753 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Retroperitoneal Limited 767753 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011 CDM 521 RC 76801 HCPCS facility both 26 587 587 Gross Charge Type: NIHD_RHC_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011 CDM 972 RC 76801 HCPCS facility both 26 720 720 Gross Charge Type: NIHD_Hosp_Tech_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011 CDM 972 RC 76801 HCPCS facility both 26 720 720 Gross Charge Type: NIHD_Hosp_Tech_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011 CDM 521 RC 76801 HCPCS facility both 26 587 587 Gross Charge Type: NIHD_Clinic_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011 CDM 972 RC 76801 HCPCS facility both 26 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011 CDM 972 RC 76801 HCPCS facility both 26 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011_402 CDM 402 RC 76801 HCPCS facility both TC 720 720 Gross Charge Type: NIHD_Hosp_Tech_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011_402 CDM 402 RC 76801 HCPCS facility both TC 720 720 Gross Charge Type: NIHD_Hosp_Tech_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011_402 CDM 402 RC 76801 HCPCS facility both TC 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price "76801 – US OB Fetal/Maternal Eval, <14 Weeks" 768011_402 CDM 402 RC 76801 HCPCS facility both TC 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Less Than 14 Weeks Single 768012 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Less Than 14 Weeks Single 768012 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Less Than 14 Weeks Single - Report 768013 CDM 972 RC 76801 HCPCS facility both 26 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Less Than 14 Weeks Single - Report 768013 CDM 972 RC 76801 HCPCS facility both 26 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US OB LESS THAN 14 WEEKS EA ADDL 76802 CDM 402 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US OB LESS THAN 14 WEEKS EA ADDL 76802 CDM 402 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price "76802 – US OB Fetal/Maternal Eval, <14 Weeks “Ea Addtl Gestation”" 768021 CDM 521 RC 76802 HCPCS facility both 332 332 Gross Charge Type: NIHD_Clinic_Price "76805 – US OB Fetal/Maternal Eval, => 14 Weeks" 768051 CDM 521 RC 76805 HCPCS facility both 26 587 587 Gross Charge Type: NIHD_Clinic_Price "76805 – US OB Fetal/Maternal Eval, => 14 Weeks" 768051 CDM 972 RC 76805 HCPCS facility both 26 247 247 Gross Charge Type: NIHD_Hosp_Profee_Price "76805 – US OB Fetal/Maternal Eval, => 14 Weeks" 768051 CDM 972 RC 76805 HCPCS facility both 26 247 247 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Greater Than 14 Weeks Single 768052 CDM 402 RC facility both TC 1006 1006 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Greater Than 14 Weeks Single 768052 CDM 402 RC facility both TC 1006 1006 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Greater Than 14 Weeks Single - Report 768053 CDM 972 RC 76805 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Greater Than 14 Weeks Single - Report 768053 CDM 972 RC 76805 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US OB GREATER THAN 14 WEEKS EA ADDL 76810 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US OB GREATER THAN 14 WEEKS EA ADDL 76810 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price "76810 – US OB Fetal/Maternal Eval, => 14 Weeks “Ea Addtl Gestation”" 768101 CDM 521 RC 76810 HCPCS facility both 332 332 Gross Charge Type: NIHD_Clinic_Price 76811 – US OB Fetal/Maternal Eval w/Detailed Fetal Anatomic Exam 76811 CDM 521 RC 76811 HCPCS facility both 254 254 Gross Charge Type: NIHD_Clinic_Price US OB Nuchal Measure 1st Trimester 768131 CDM 402 RC facility both TC 520 520 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Nuchal Measure 1st Trimester 768131 CDM 402 RC facility both TC 520 520 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Nuchal Measure 1st Trimester - Report 768132 CDM 972 RC 76813 HCPCS facility both 26 379 379 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Nuchal Measure 1st Trimester - Report 768132 CDM 972 RC 76813 HCPCS facility both 26 379 379 Gross Charge Type: NIHD_Hosp_Profee_Price 76815 POCUS OB Limited TechFee 76815 CDM 450 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price 76815 POCUS OB Limited TechFee 76815 CDM 450 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES 768151 CDM 982 RC 76815 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES 768151 CDM 982 RC 76815 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Limited - Report 768152 CDM 972 RC 76815 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Limited - Report 768152 CDM 972 RC 76815 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price "US OB Limited 76815, 1 or More Fetus" 768153 CDM 521 RC 76815 HCPCS facility both 427 427 Gross Charge Type: NIHD_Clinic_Price US OB Limited 768154 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Limited 768154 CDM 402 RC facility both TC 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price 76815 - US OB Limited Exam Only 768156 CDM 972 RC 76815 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price 76815 - US OB Limited Exam Only 768156 CDM 972 RC 76815 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price 76815 - US OB Limited Exam Only 768157 CDM 972 RC 76815 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price 76815 - US OB Limited Exam Only 768157 CDM 972 RC 76815 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price 76816 – US OB Follow-Up 768161 CDM 521 RC 76816 HCPCS facility both 26 381 381 Gross Charge Type: NIHD_Clinic_Price 76816 – US OB Follow-Up 768161 CDM 972 RC 76816 HCPCS facility both 26 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price 76816 – US OB Follow-Up 768161 CDM 972 RC 76816 HCPCS facility both 26 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Follow Up - Report 768162 CDM 972 RC 76816 HCPCS facility both 26 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Follow Up - Report 768162 CDM 972 RC 76816 HCPCS facility both 26 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Follow Up 768163 CDM 402 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price US OB Follow Up 768163 CDM 402 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price 76817 POCUS Transvaginal OB Limited TechFee 76817 CDM 450 RC facility both 829 829 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US OB TRANSVAGINAL 76817 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 76817 POCUS Transvaginal OB Limited TechFee 76817 CDM 450 RC facility both 829 829 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US OB TRANSVAGINAL 76817 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 76817 US Preg Uterus Real Time W/Image Dcmtn Transvag 768171 CDM 982 RC 76817 HCPCS facility both 26 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price 76817 US Preg Uterus Real Time W/Image Dcmtn Transvag 768171 CDM 982 RC 76817 HCPCS facility both 26 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price US OB 76817 Transvaginal 768174 CDM 402 RC 76817 HCPCS facility both 498 498 Gross Charge Type: NIHD_RHC_Price US OB 76817 Transvaginal 768174 CDM 402 RC 76817 HCPCS facility both 498 498 Gross Charge Type: NIHD_Clinic_Price US OB 76817 Transvaginal 768174 CDM 972 RC 76817 HCPCS facility both 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price US OB 76817 Transvaginal 768174 CDM 972 RC 76817 HCPCS facility both 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price 76818 – US Biophysical Profile w/Nonstress 768181 CDM 521 RC 76818 HCPCS facility both 580 580 Gross Charge Type: NIHD_RHC_Price 76818 – US Biophysical Profile w/Nonstress 768181 CDM 76818 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 76818 – US Biophysical Profile w/Nonstress 768181 CDM 76818 HCPCS facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Fetal Biophysical Profile w/ Non-Str - Report 768182 CDM 972 RC 76818 HCPCS facility both 26 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Fetal Biophysical Profile w/ Non-Str - Report 768182 CDM 972 RC 76818 HCPCS facility both 26 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Fetal Biophysical Profile w/ Non-Str 768183 CDM 402 RC facility both TC 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price US Fetal Biophysical Profile w/ Non-Str 768183 CDM 402 RC facility both TC 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price 76819 – US Fetal Biophysical wo Nonstress 76819 CDM 972 RC 76819 HCPCS facility both 142 142 Gross Charge Type: NIHD_Hosp_Profee_Price 76819 – US Fetal Biophysical wo Nonstress 76819 CDM 972 RC 76819 HCPCS facility both 142 142 Gross Charge Type: NIHD_Hosp_Profee_Price "76820 US OB Doppler Velocimtry, Fetal" 768201 CDM 521 RC 76820 HCPCS facility both 91 91 Gross Charge Type: NIHD_RHC_Price US Doppler Umbilical Artery 768202 CDM 402 RC facility both TC 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price US Doppler Umbilical Artery 768202 CDM 402 RC facility both TC 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price US Doppler Umbilical Artery - Report 768203 CDM 972 RC 76820 HCPCS facility both 26 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price US Doppler Umbilical Artery - Report 768203 CDM 972 RC 76820 HCPCS facility both 26 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price "76821 Doppler velocimetry, fetal; middle cerebral artery" 76821 CDM 521 RC 76821 HCPCS facility both 176 176 Gross Charge Type: NIHD_RHC_Price "76825 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with" 76825 CDM 521 RC 76825 HCPCS facility both 527 527 Gross Charge Type: NIHD_RHC_Price "76826 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D)" 76826 CDM 521 RC 76826 HCPCS facility both 313 313 Gross Charge Type: NIHD_RHC_Price NIHD US TRANSVAGINAL NON-OB 76830 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US TRANSVAGINAL NON-OB 76830 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 76830 – US Transvaginal (Not OB) 768301 CDM 400 RC 76830 HCPCS facility both 530 530 Gross Charge Type: NIHD_RHC_Price 76830 – US Transvaginal (Not OB) 768301 CDM 400 RC 76830 HCPCS facility both 530 530 Gross Charge Type: NIHD_Clinic_Price NIHD US OB TRANSVAGINAL 768302 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US OB TRANSVAGINAL 768302 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Transvaginal Non-OB - Report 768303 CDM 972 RC 76830 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price US Transvaginal Non-OB - Report 768303 CDM 972 RC 76830 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price US Transvaginal Non-OB 768304 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Transvaginal Non-OB 768304 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 76831 – US Saline Infused 76831 CDM 521 RC 76831 HCPCS facility both 814 814 Gross Charge Type: NIHD_RHC_Price "76856 – US Pelvic, Complete, Non OB" 768561 CDM 400 RC 76856 HCPCS facility both 466 466 Gross Charge Type: NIHD_RHC_Price "76856 – US Pelvic, Complete, Non OB" 768561 CDM 400 RC 76856 HCPCS facility both 466 466 Gross Charge Type: NIHD_Clinic_Price NIHD US TRANSVAGINAL NON-OB 768562 CDM 402 RC facility both TC 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US TRANSVAGINAL NON-OB 768562 CDM 402 RC facility both TC 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price US Pelvic Complete 768563 CDM 402 RC facility both TC 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price US Pelvic Complete 768563 CDM 402 RC facility both TC 964 964 Gross Charge Type: NIHD_Hosp_Profee_Price US Pelvic Complete - Report 768564 CDM 972 RC 76856 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price US Pelvic Complete - Report 768564 CDM 972 RC 76856 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price 76857 POCUS Pelvic Limited TechFee 76857 CDM 402 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price 76857 POCUS Pelvic Limited TechFee 76857 CDM 402 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price 76857 POCUS Pelvic Limited ProFee 768571 CDM 972 RC 76857 HCPCS facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price 76857 POCUS Pelvic Limited ProFee 768571 CDM 972 RC 76857 HCPCS facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Buttocks or Pelvic Wall - Report 7685710 CDM 972 RC 76857 HCPCS facility both 26 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Buttocks or Pelvic Wall - Report 7685710 CDM 972 RC 76857 HCPCS facility both 26 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price "76857 US EXAM, PELVIC, LIMITED" 7685711 CDM 521 RC 76857 HCPCS facility both 37 37 Gross Charge Type: NIHD_RHC_Price "76857 US EXAM, PELVIC, LIMITED" 7685711 CDM 521 RC 76857 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price US Pelvic Ltd - Report 768574 CDM 972 RC 76857 HCPCS facility both 26 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price US Pelvic Ltd - Report 768574 CDM 972 RC 76857 HCPCS facility both 26 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price US Pelvic Ltd 768575 CDM 402 RC facility both TCLT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price US Pelvic Ltd 768575 CDM 402 RC facility both TCLT 629 629 Gross Charge Type: NIHD_Hosp_Profee_Price US Scrotum (Contents) 768701 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Scrotum (Contents) 768701 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Scrotum (Contents) - Report 768702 CDM 972 RC 76870 HCPCS facility both 26 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price US Scrotum (Contents) - Report 768702 CDM 972 RC 76870 HCPCS facility both 26 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price 76872 Transrectal Ultrasound-INYO 76872 CDM 320 RC 76872 HCPCS facility both 329 329 Gross Charge Type: NIHD_RHC_Price 76872 Transrectal Ultrasound-INYO 76872 CDM 320 RC 76872 HCPCS facility both 329 329 Gross Charge Type: NIHD_Clinic_Price 76872 Transrectal Ultrasound 768721 CDM 76872 HCPCS facility both 329 329 Gross Charge Type: NIHD_Clinic_Price 76872 US TRANSRECTAL 768722 CDM 761 RC facility both TC 732 732 Gross Charge Type: NIHD_Hosp_Profee_Price 76872 US TRANSRECTAL 768722 CDM 761 RC facility both TC 732 732 Gross Charge Type: NIHD_Hosp_Profee_Price 76872 US ECHO TRANSRECTAL ProFee 768723 CDM 982 RC 76872 HCPCS facility both 26 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price 76872 US ECHO TRANSRECTAL ProFee 768723 CDM 982 RC 76872 HCPCS facility both 26 218 218 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Complete Left 768811 CDM 402 RC facility both TCLT 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Complete Left 768811 CDM 402 RC facility both TCLT 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Complete Left - Report 768812 CDM 972 RC 76881 HCPCS facility both 26LT 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Complete Left - Report 768812 CDM 972 RC 76881 HCPCS facility both 26LT 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Complete Right 768813 CDM 402 RC facility both TCRT 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Complete Right 768813 CDM 402 RC facility both TCRT 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Complete Right - Report 768814 CDM 972 RC 76881 HCPCS facility both 26RT 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Complete Right - Report 768814 CDM 972 RC 76881 HCPCS facility both 26RT 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Bilateral - Report 768815 CDM 972 RC 76881 HCPCS facility both 26 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Bilateral - Report 768815 CDM 972 RC 76881 HCPCS facility both 26 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Bilateral 768816 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Bilateral 768816 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 76881 US Axilla Bilateral Tech 768817 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price 76881 US Axilla Bilateral Tech 768817 CDM 402 RC facility both TC 838 838 Gross Charge Type: NIHD_Hosp_Profee_Price "76881 US EXTREM, NON VAS COMPLETE ProFee" 768818 CDM 972 RC 76881 HCPCS facility both 26 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price "76881 US EXTREM, NON VAS COMPLETE ProFee" 768818 CDM 972 RC 76881 HCPCS facility both 26 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price 76882 US Lwr Extrem Non Vasc Ltd LT 76882 CDM 402 RC facility both 541 541 Gross Charge Type: NIHD_Hosp_Profee_Price 76882 US Lwr Extrem Non Vasc Ltd LT 76882 CDM 402 RC facility both 541 541 Gross Charge Type: NIHD_Hosp_Profee_Price "76882 US EXTREM, NON VAS LIMITED ProFee" 768821 CDM 972 RC 76882 HCPCS facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price "76882 US EXTREM, NON VAS LIMITED ProFee" 768821 CDM 972 RC 76882 HCPCS facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Groin 7688211 CDM 402 RC facility both TC 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Groin 7688211 CDM 402 RC facility both TC 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Groin - Report 7688212 CDM 972 RC 76882 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price US Soft Tissue Groin - Report 7688212 CDM 972 RC 76882 HCPCS facility both 26 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Right 768822 CDM 402 RC facility both TCRT 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Right 768822 CDM 402 RC facility both TCRT 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Right - Report 768823 CDM 972 RC 76882 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Right - Report 768823 CDM 972 RC 76882 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Left 768824 CDM 402 RC facility both TCLT 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Left 768824 CDM 402 RC facility both TCLT 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Left - Report 768825 CDM 972 RC 76882 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Axilla Left - Report 768825 CDM 972 RC 76882 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Limited Left 768826 CDM 402 RC facility both TCLT 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Limited Left 768826 CDM 402 RC facility both TCLT 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Limited Left - Report 768827 CDM 982 RC 76882 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Limited Left - Report 768827 CDM 982 RC 76882 HCPCS facility both 26LT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Limited Right 768828 CDM 402 RC facility both TCRT 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Limited Right 768828 CDM 402 RC facility both TCRT 471 471 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Limited Right - Report 768829 CDM 982 RC 76882 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Extremity Nonvascular Limited Right - Report 768829 CDM 982 RC 76882 HCPCS facility both 26RT 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price US Hips Infant Dynamic - Report 768851 CDM 972 RC 76885 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Hips Infant Dynamic - Report 768851 CDM 972 RC 76885 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price US Hips Infant Dynamic 768852 CDM 402 RC facility both TC 786 786 Gross Charge Type: NIHD_Hosp_Profee_Price US Hips Infant Dynamic 768852 CDM 402 RC facility both TC 786 786 Gross Charge Type: NIHD_Hosp_Profee_Price 76937 POCUS Vascular Access TechFee 76937 CDM 402 RC facility both 793 793 Gross Charge Type: NIHD_Hosp_Profee_Price 76937 POCUS Vascular Access TechFee 76937 CDM 402 RC facility both 793 793 Gross Charge Type: NIHD_Hosp_Profee_Price 76937 US GUID VASCULAR ACCESS EVAL PATENCY VIS 769371 CDM 982 RC 76937 HCPCS facility both 26 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price 76937 US GUID VASCULAR ACCESS EVAL PATENCY VIS 769371 CDM 982 RC 76937 HCPCS facility both 26 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price 76937 ULTRASOUND GUIDANCE PICC PLCMT ProFee 769372 CDM 963 RC 76937 HCPCS facility both 239 239 Gross Charge Type: NIHD_Hosp_Profee_Price 76937 ULTRASOUND GUIDANCE PICC PLCMT ProFee 769372 CDM 963 RC 76937 HCPCS facility both 239 239 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Vascular Access 769374 CDM 402 RC facility both TC 691 691 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Vascular Access 769374 CDM 402 RC facility both TC 691 691 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Vascular Access - Report 769375 CDM 972 RC 76937 HCPCS facility both 26 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Vascular Access - Report 769375 CDM 972 RC 76937 HCPCS facility both 26 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price 76942 POCUS Needle Guided Placement TechFee 76942 CDM 450 RC facility both 1176 1176 Gross Charge Type: NIHD_Hosp_Profee_Price 76942 POCUS Needle Guided Placement TechFee 76942 CDM 450 RC facility both 1176 1176 Gross Charge Type: NIHD_Hosp_Profee_Price 76942 US GUIDANCE NEEDLE PLACEMENT IMG S&I 769422 CDM 982 RC 76942 HCPCS facility both 26 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price 76942 US GUIDANCE NEEDLE PLACEMENT IMG S&I 769422 CDM 982 RC 76942 HCPCS facility both 26 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US GUIDANCE 769424 CDM 402 RC facility both TC 1027 1027 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD US GUIDANCE 769424 CDM 402 RC facility both TC 1027 1027 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Needle Placement - Report 769426 CDM 972 RC 76942 HCPCS facility both 26 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price US Guided Needle Placement - Report 769426 CDM 972 RC 76942 HCPCS facility both 26 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price US Intraoperative 769427 CDM 402 RC facility both TC 1027 1027 Gross Charge Type: NIHD_Hosp_Profee_Price US Intraoperative 769427 CDM 402 RC facility both TC 1027 1027 Gross Charge Type: NIHD_Hosp_Profee_Price "76942 Ultrasonic guidance for needle placement, imaging supervision and interpretation" 769428 CDM 521 RC 76942 HCPCS facility both 91 91 Gross Charge Type: NIHD_RHC_Price "76942 Ultrasonic guidance for needle placement, imaging supervision and interpretation" 769428 CDM 521 RC 76942 HCPCS facility both 91 91 Gross Charge Type: NIHD_Clinic_Price APAP-HYDROcodone 325 mg-5 mg Tab [INYO] 76982 CDM 00406-0123-62 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB APAP-HYDROcodone 325 mg-5 mg Tab [INYO] 76982 CDM 27808-0035-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB APAP-HYDROcodone 325 mg-5 mg Tab [INYO] 76982 CDM 53746-0109-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 77001 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT ProFee 770011 CDM 09820972 RC 77001 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 77001 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT ProFee 770011 CDM 09820972 RC 77001 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price XR Fluoro Venous Access 770012 CDM 320 RC facility both TC 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price XR Fluoro Venous Access 770012 CDM 320 RC facility both TC 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price XR Fluoro Venous Access - Report 770013 CDM 972 RC 77001 HCPCS facility both 26 278 278 Gross Charge Type: NIHD_Hosp_Profee_Price XR Fluoro Venous Access - Report 770013 CDM 972 RC 77001 HCPCS facility both 26 278 278 Gross Charge Type: NIHD_Hosp_Profee_Price 77001 XR Placement CVAD w/ Fluoro 770014 CDM 320 RC facility both TC 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price 77001 XR Placement CVAD w/ Fluoro 770014 CDM 320 RC facility both TC 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price 77002 FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT - HUMB 770022 CDM 982 RC 77002 HCPCS facility both 26 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price 77002 FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT - HUMB 770022 CDM 982 RC 77002 HCPCS facility both 26 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price 77002 FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ProFee 770023 CDM 320 RC facility both TC 817 817 Gross Charge Type: NIHD_Hosp_Profee_Price 77002 FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ProFee 770023 CDM 320 RC facility both TC 817 817 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FLUORO GUIDANCE NEEDLE PLCMT 770024 CDM 320 RC facility both TC 817 817 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FLUORO GUIDANCE NEEDLE PLCMT 770024 CDM 320 RC facility both TC 817 817 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FLUORO GUIDANCE 770025 CDM 320 RC facility both TC 817 817 Gross Charge Type: NIHD_Hosp_Profee_Price NIHD XR FLUORO GUIDANCE 770025 CDM 320 RC facility both TC 817 817 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Left 770461 CDM 610 RC facility both LTTC 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Left 770461 CDM 610 RC facility both LTTC 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Left - Report 770462 CDM 972 RC 77046 HCPCS facility both 26LT 415 415 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Left - Report 770462 CDM 972 RC 77046 HCPCS facility both 26LT 415 415 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Right 770463 CDM 610 RC facility both TCRT 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Right 770463 CDM 610 RC facility both TCRT 927 927 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Right - Report 770464 CDM 972 RC 77046 HCPCS facility both 26RT 415 415 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Right - Report 770464 CDM 972 RC 77046 HCPCS facility both 26RT 415 415 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ Contrast Bilateral - Report 770471 CDM 972 RC 77047 HCPCS facility both 2650 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ Contrast Bilateral - Report 770471 CDM 972 RC 77047 HCPCS facility both 2650 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ Contrast Bilateral 770472 CDM 610 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ Contrast Bilateral 770472 CDM 610 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Bilateral 770473 CDM 610 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Bilateral 770473 CDM 610 RC facility both TC 2388 2388 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Bilateral - Report 770474 CDM 972 RC 77047 HCPCS facility both 2650 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/o Contrast Bilateral - Report 770474 CDM 972 RC 77047 HCPCS facility both 2650 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Left 770481 CDM 610 RC facility both TCLT 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Left 770481 CDM 610 RC facility both TCLT 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Right 770483 CDM 610 RC facility both TCRT 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Right 770483 CDM 610 RC facility both TCRT 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Right - Report 770484 CDM 972 RC 77048 HCPCS facility both 26RT 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Right - Report 770484 CDM 972 RC 77048 HCPCS facility both 26RT 454 454 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Bilateral 770491 CDM 610 RC facility both TC 2409 2409 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Bilateral 770491 CDM 610 RC facility both TC 2409 2409 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Bilateral. - Report 770492 CDM 972 RC 77049 HCPCS facility both 2650 673 673 Gross Charge Type: NIHD_Hosp_Profee_Price MRI Breast w/ + w/o Contrast Bilateral - Report 770492 CDM 972 RC 77049 HCPCS facility both 2650 673 673 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Single Left 770533 CDM 401 RC facility both TCLT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Single Left 770533 CDM 401 RC facility both TCLT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Single Right 770535 CDM 401 RC facility both TCRT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Single Right 770535 CDM 401 RC facility both TCRT 754 754 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Multiple Lt 770542 CDM 320 RC facility both TCLT 962 962 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Multiple Lt 770542 CDM 320 RC facility both TCLT 962 962 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Multiple Lt - Report 770543 CDM 972 RC 77054 HCPCS facility both 26LT 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Multiple Lt - Report 770543 CDM 972 RC 77054 HCPCS facility both 26LT 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Multiple Rt 770544 CDM 320 RC facility both TCRT 962 962 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Multiple Rt 770544 CDM 320 RC facility both TCRT 962 962 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Multiple Rt - Report 770545 CDM 972 RC 77054 HCPCS facility both 26RT 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price MG Ductogram or Galactogram Multiple Rt - Report 770545 CDM 972 RC 77054 HCPCS facility both 26RT 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 77061 MG Diagnostic Tomo Unilateral PROFEE 770613 CDM 972 RC 77061 HCPCS facility both 26 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 77061 MG Diagnostic Tomo Unilateral PROFEE 770613 CDM 972 RC 77061 HCPCS facility both 26 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 77061 MG Diagnostic Right w / tomo 770614 CDM 401 RC facility both TC 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price 77061 MG Diagnostic Right w / tomo 770614 CDM 401 RC facility both TC 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price 77062 MG Diagnostic Tomo Bilateral 77062 CDM 401 RC facility both TC 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price 77062 MG Diagnostic Tomo Bilateral 77062 CDM 401 RC facility both TC 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price 77062 MG Diagnostic Tomo Bilateral PROFEE 770622 CDM 972 RC 77062 HCPCS facility both 26 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 77062 MG Diagnostic Tomo Bilateral PROFEE 770622 CDM 972 RC 77062 HCPCS facility both 26 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 77063 MG MAMMO SCREEN TOMO BILAT:PROF 7706310 CDM 972 RC 77063 HCPCS facility both 26 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price 77063 MG MAMMO SCREEN TOMO BILAT:PROF 7706310 CDM 972 RC 77063 HCPCS facility both 26 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price 77063 MG MAMMO SCREENING TOMO BILAT 770636 CDM 403 RC facility both TC 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price 77063 MG MAMMO SCREENING TOMO BILAT 770636 CDM 403 RC facility both TC 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Left w/ Tomo. 770651 CDM 401 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Left w/ Tomo. 770651 CDM 401 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Left w/ Tomo. - Report 7706510 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Left w/ Tomo. - Report 7706510 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Right w/ Tomo. 7706511 CDM 401 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Right w/ Tomo. 7706511 CDM 401 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Right w/ Tomo. - Report 7706512 CDM 972 RC 77065 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Right w/ Tomo. - Report 7706512 CDM 972 RC 77065 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Left. 7706513 CDM 401 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Left. 7706513 CDM 401 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Left. - Report 7706514 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Left. - Report 7706514 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Right. 7706515 CDM 401 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Right. 7706515 CDM 401 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Right. - Report 7706516 CDM 972 RC 77065 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Right. - Report 7706516 CDM 972 RC 77065 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price 77065 MG Mammo Diagnostic w/tomo profee 7706517 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price 77065 MG Mammo Diagnostic w/tomo profee 7706517 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI ProFee 7706518 CDM 401 RC facility both TC 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI ProFee 7706518 CDM 401 RC facility both TC 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Left w/ Tomo. - Report 770652 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Left w/ Tomo. - Report 770652 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Right w/ Tomo. 770653 CDM 401 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Right w/ Tomo. 770653 CDM 401 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Right w/ Tomo. - Report 770654 CDM 972 RC 77065 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Right w/ Tomo. - Report 770654 CDM 972 RC 77065 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Left. 770655 CDM 401 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Left. 770655 CDM 401 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Left. - Report 770656 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Left. - Report 770656 CDM 972 RC 77065 HCPCS facility both 26LT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Right. 770657 CDM 401 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Right. 770657 CDM 401 RC facility both TCRT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Right. - Report 770658 CDM 972 RC 77065 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Right. - Report 770658 CDM 972 RC 77065 HCPCS facility both 26RT 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Left w/ Tomo. 770659 CDM 401 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Left w/ Tomo. 770659 CDM 401 RC facility both TCLT 419 419 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Bilateral w/ Tomo. 770661 CDM 401 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Bilateral w/ Tomo. 770661 CDM 401 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price 77066 MG Mammo Diagnostic Bilateral 7706610 CDM 401 RC facility both TC 500 500 Gross Charge Type: NIHD_Hosp_Profee_Price 77066 MG Mammo Diagnostic Bilateral 7706610 CDM 401 RC facility both TC 500 500 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Bilateral w/ Tomo. - Report 770662 CDM 972 RC 77066 HCPCS facility both 2650 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Bilateral w/ Tomo. - Report 770662 CDM 972 RC 77066 HCPCS facility both 2650 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Bilateral. 770663 CDM 401 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Bilateral. 770663 CDM 401 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Bilateral. - Report 770664 CDM 972 RC 77066 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Diagnostic Bilateral. - Report 770664 CDM 972 RC 77066 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Bilateral w/ Tomo. 770665 CDM 401 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Bilateral w/ Tomo. 770665 CDM 401 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Bilateral w/ Tomo. - Report 770666 CDM 972 RC 77066 HCPCS facility both 2650 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Diag Bilateral w/ Tomo. - Report 770666 CDM 972 RC 77066 HCPCS facility both 2650 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Bilateral. 770667 CDM 401 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Bilateral. 770667 CDM 401 RC facility both TC 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Bilateral. - Report 770668 CDM 972 RC 77066 HCPCS facility both 2650 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Digital Diag Bilateral. - Report 770668 CDM 972 RC 77066 HCPCS facility both 2650 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price 77066 MG Mammo Diagnostic PROFEE 770669 CDM 972 RC 77066 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price 77066 MG Mammo Diagnostic PROFEE 770669 CDM 972 RC 77066 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Bilateral w/ Tomo. 770671 CDM 403 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Bilateral w/ Tomo. 770671 CDM 403 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price 77067 MG Mammo Digital Screening PROFEE 7706710 CDM 972 RC 77067 HCPCS facility both 26 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price 77067 MG Mammo Digital Screening PROFEE 7706710 CDM 972 RC 77067 HCPCS facility both 26 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price 77067 MG Mammo Digital Screening Bilateral 7706711 CDM 403 RC facility both TC 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price 77067 MG Mammo Digital Screening Bilateral 7706711 CDM 403 RC facility both TC 380 380 Gross Charge Type: NIHD_Hosp_Profee_Price 77067 MG MAMMO SCREEN W/CAD BIL:PROF 7706712 CDM 972 RC 77067 HCPCS facility both 26 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price 77067 MG MAMMO SCREEN W/CAD BIL:PROF 7706712 CDM 972 RC 77067 HCPCS facility both 26 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Bilateral w/ Tomo. - Report 770672 CDM 972 RC 77067 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Bilateral w/ Tomo. - Report 770672 CDM 972 RC 77067 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Left w/ Tomo. 770673 CDM 403 RC facility both TCLT 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Left w/ Tomo. 770673 CDM 403 RC facility both TCLT 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Left w/ Tomo. - Report 770674 CDM 972 RC 77067 HCPCS facility both 26LT 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Left w/ Tomo. - Report 770674 CDM 972 RC 77067 HCPCS facility both 26LT 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Right w/ Tomo. 770675 CDM 403 RC facility both TCRT 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Right w/ Tomo. 770675 CDM 403 RC facility both TCRT 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Right w/ Tomo. - Report 770676 CDM 972 RC 77067 HCPCS facility both 26RT 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Screening Right w/ Tomo. - Report 770676 CDM 972 RC 77067 HCPCS facility both 26RT 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Screening Bil w/ Tomo. 770677 CDM 403 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Screening Bil w/ Tomo. 770677 CDM 403 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Screening Bil w/ Tomo. - Report 770678 CDM 972 RC 77067 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price MG Mammo Implant Screening Bil w/ Tomo. - Report 770678 CDM 972 RC 77067 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 77067 MG Mammo Screening Right w/ Tomo. Rad Charge 770679 CDM 403 RC facility both TCRT 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price 77067 MG Mammo Screening Right w/ Tomo. Rad Charge 770679 CDM 403 RC facility both TCRT 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price XR Bone Age Studies - Report 770721 CDM 972 RC 77072 HCPCS facility both 26 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Bone Age Studies - Report 770721 CDM 972 RC 77072 HCPCS facility both 26 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Bone Age Studies 770722 CDM 320 RC facility both TC 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price XR Bone Age Studies 770722 CDM 320 RC facility both TC 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price XR Bone Length Studies Scanograms - Report 770731 CDM 972 RC 77073 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price XR Bone Length Studies Scanograms - Report 770731 CDM 972 RC 77073 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price XR Bone Length Studies Scanograms 770732 CDM 320 RC facility both TC 513 513 Gross Charge Type: NIHD_Hosp_Profee_Price XR Bone Length Studies Scanograms 770732 CDM 320 RC facility both TC 513 513 Gross Charge Type: NIHD_Hosp_Profee_Price 77073 XR Bone Length Study PROFEE 770733 CDM 972 RC 77073 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 77073 XR Bone Length Study PROFEE 770733 CDM 972 RC 77073 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price XR Osseous Survey Complete - Report 770751 CDM 972 RC 77075 HCPCS facility both 26 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price XR Osseous Survey Complete - Report 770751 CDM 972 RC 77075 HCPCS facility both 26 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price XR Osseous Survey Complete 770752 CDM 320 RC facility both TC 1058 1058 Gross Charge Type: NIHD_Hosp_Profee_Price XR Osseous Survey Complete 770752 CDM 320 RC facility both TC 1058 1058 Gross Charge Type: NIHD_Hosp_Profee_Price XR Osseous Survey Infant - Report 770761 CDM 972 RC 77076 HCPCS facility both 26 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price XR Osseous Survey Infant - Report 770761 CDM 972 RC 77076 HCPCS facility both 26 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price XR Osseous Survey Infant 770762 CDM 320 RC facility both TC 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price XR Osseous Survey Infant 770762 CDM 320 RC facility both TC 581 581 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint Survey Single View 2+ Joints - Report 770771 CDM 982 RC 77077 HCPCS facility both 26 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint Survey Single View 2+ Joints - Report 770771 CDM 982 RC 77077 HCPCS facility both 26 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint Survey Single View 2+ Joints 770772 CDM 320 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price XR Joint Survey Single View 2+ Joints 770772 CDM 320 RC facility both TC 398 398 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA Axial Skeleton - Report 770801 CDM 972 RC 77080 HCPCS facility both 26 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA Axial Skeleton - Report 770801 CDM 972 RC 77080 HCPCS facility both 26 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA Axial Skeleton 770802 CDM 320 RC facility both TC 482 482 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA Axial Skeleton 770802 CDM 320 RC facility both TC 482 482 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA App Skeleton - Report 770811 CDM 972 RC 77081 HCPCS facility both 26 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA App Skeleton - Report 770811 CDM 972 RC 77081 HCPCS facility both 26 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA App Skeleton 770812 CDM 320 RC facility both TC 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA App Skeleton 770812 CDM 320 RC facility both TC 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA Vert Fracture Assmt 770861 CDM 320 RC facility both TC 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA Vert Fracture Assmt 770861 CDM 320 RC facility both TC 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA Vert Fracture Assmt - Report 770862 CDM 972 RC 77086 HCPCS facility both 26 62 62 Gross Charge Type: NIHD_Hosp_Profee_Price BD Bone Density DEXA Vert Fracture Assmt - Report 770862 CDM 972 RC 77086 HCPCS facility both 26 62 62 Gross Charge Type: NIHD_Hosp_Profee_Price ARROW TEMPORARY PACEMAKER KIT 7715110 CDM 272 RC facility both 935 935 Gross Charge Type: NIHD_Hosp_Profee_Price ARROW TEMPORARY PACEMAKER KIT 7715110 CDM 272 RC facility both 935 935 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING LYOFOAM MAX 4X4 7719230 CDM 272 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING LYOFOAM MAX 4X4 7719230 CDM 272 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price zzNIHD US OB NUCHAL MEASUREMENT EA ADDL 78013 CDM 341 RC facility both TC 955 955 Gross Charge Type: NIHD_Hosp_Profee_Price zzNIHD US OB NUCHAL MEASUREMENT EA ADDL 78013 CDM 341 RC facility both TC 955 955 Gross Charge Type: NIHD_Hosp_Profee_Price NM Thyroid Image w/ Uptake Sngl or Multi 780142 CDM 340 RC facility both TC 1535 1535 Gross Charge Type: NIHD_Hosp_Profee_Price NM Thyroid Image w/ Uptake Sngl or Multi 780142 CDM 340 RC facility both TC 1535 1535 Gross Charge Type: NIHD_Hosp_Profee_Price NM Thyroid Image w/ Uptake Sngl or Multi - Report 780143 CDM 974 RC 78014 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price NM Thyroid Image w/ Uptake Sngl or Multi - Report 780143 CDM 974 RC 78014 HCPCS facility both 26 421 421 Gross Charge Type: NIHD_Hosp_Profee_Price NM Parathyroid Imaging - Report 780701 CDM 974 RC 78070 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price NM Parathyroid Imaging - Report 780701 CDM 974 RC 78070 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price NM Parathyroid Imaging 780702 CDM 341 RC facility both TC 1592 1592 Gross Charge Type: NIHD_Hosp_Profee_Price NM Parathyroid Imaging 780702 CDM 341 RC facility both TC 1592 1592 Gross Charge Type: NIHD_Hosp_Profee_Price NM Parathyroid Imaging w/ Spect - Report 780711 CDM 974 RC 78071 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price NM Parathyroid Imaging w/ Spect - Report 780711 CDM 974 RC 78071 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price NM Parathyroid Imaging w/ Spect 780712 CDM 341 RC facility both TC 1592 1592 Gross Charge Type: NIHD_Hosp_Profee_Price NM Parathyroid Imaging w/ Spect 780712 CDM 341 RC facility both TC 1592 1592 Gross Charge Type: NIHD_Hosp_Profee_Price NM Adrenal Imaging 78075 CDM 341 RC facility both TC 3201 3201 Gross Charge Type: NIHD_Hosp_Profee_Price NM Adrenal Imaging 78075 CDM 341 RC facility both TC 3201 3201 Gross Charge Type: NIHD_Hosp_Profee_Price NM Adrenal Imaging - Report 780751 CDM 972 RC 78075 HCPCS facility both 26 678 678 Gross Charge Type: NIHD_Hosp_Profee_Price NM Adrenal Imaging - Report 780751 CDM 972 RC 78075 HCPCS facility both 26 678 678 Gross Charge Type: NIHD_Hosp_Profee_Price MRV Brain w/o contrast 780753 CDM 615 RC facility both TC 3201 3201 Gross Charge Type: NIHD_Hosp_Profee_Price MRV Brain w/o contrast 780753 CDM 615 RC facility both TC 3201 3201 Gross Charge Type: NIHD_Hosp_Profee_Price NM Thyroid Imaging 780754 CDM 341 RC facility both TC 3201 3201 Gross Charge Type: NIHD_Hosp_Profee_Price NM Thyroid Imaging 780754 CDM 341 RC facility both TC 3201 3201 Gross Charge Type: NIHD_Hosp_Profee_Price NM Thyroid Imaging - Report 780755 CDM 974 RC 78075 HCPCS facility both 26 678 678 Gross Charge Type: NIHD_Hosp_Profee_Price NM Thyroid Imaging - Report 780755 CDM 974 RC 78075 HCPCS facility both 26 678 678 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lymphoscintigraphy - Report 781951 CDM 974 RC 78195 HCPCS facility both 26 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lymphoscintigraphy - Report 781951 CDM 974 RC 78195 HCPCS facility both 26 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lymphoscintigraphy 781952 CDM 341 RC facility both TC 1922 1922 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lymphoscintigraphy 781952 CDM 341 RC facility both TC 1922 1922 Gross Charge Type: NIHD_Hosp_Profee_Price NM Sentinel Node 781953 CDM 341 RC facility both TC 1922 1922 Gross Charge Type: NIHD_Hosp_Profee_Price NM Sentinel Node 781953 CDM 341 RC facility both TC 1922 1922 Gross Charge Type: NIHD_Hosp_Profee_Price NM Sentinel Node - Report 781954 CDM 974 RC 78195 HCPCS facility both 26 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price NM Sentinel Node - Report 781954 CDM 974 RC 78195 HCPCS facility both 26 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price NM Liver/Spleen Imaging - Report 782151 CDM 974 RC 78215 HCPCS facility both 26 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price NM Liver/Spleen Imaging - Report 782151 CDM 974 RC 78215 HCPCS facility both 26 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price NM Liver/Spleen Imaging 782152 CDM 341 RC facility both TC 1660 1660 Gross Charge Type: NIHD_Hosp_Profee_Price NM Liver/Spleen Imaging 782152 CDM 341 RC facility both TC 1660 1660 Gross Charge Type: NIHD_Hosp_Profee_Price NM Hepatobiliary Imaging 782261 CDM 341 RC facility both TC 1943 1943 Gross Charge Type: NIHD_Hosp_Profee_Price NM Hepatobiliary Imaging 782261 CDM 341 RC facility both TC 1943 1943 Gross Charge Type: NIHD_Hosp_Profee_Price NM Hepatobiliary Imaging - Report 782262 CDM 974 RC 78226 HCPCS facility both 26 528 528 Gross Charge Type: NIHD_Hosp_Profee_Price NM Hepatobiliary Imaging - Report 782262 CDM 974 RC 78226 HCPCS facility both 26 528 528 Gross Charge Type: NIHD_Hosp_Profee_Price NM Hepatobiliary Imaging w/ Drug 782271 CDM 341 RC facility both TC 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price NM Hepatobiliary Imaging w/ Drug 782271 CDM 341 RC facility both TC 1934 1934 Gross Charge Type: NIHD_Hosp_Profee_Price NM Hepatobiliary Imaging w/ Drug - Report 782272 CDM 974 RC 78227 HCPCS facility both 26 528 528 Gross Charge Type: NIHD_Hosp_Profee_Price NM Hepatobiliary Imaging w/ Drug - Report 782272 CDM 974 RC 78227 HCPCS facility both 26 528 528 Gross Charge Type: NIHD_Hosp_Profee_Price NM Gastric Emptying Study - Report 782641 CDM 974 RC 78264 HCPCS facility both 26 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price NM Gastric Emptying Study - Report 782641 CDM 974 RC 78264 HCPCS facility both 26 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price NM Gastric Emptying Study 782642 CDM 341 RC facility both TC 1927 1927 Gross Charge Type: NIHD_Hosp_Profee_Price NM Gastric Emptying Study 782642 CDM 341 RC facility both TC 1927 1927 Gross Charge Type: NIHD_Hosp_Profee_Price NM Gastrointestinal Blood Loss Imaging - Report 782781 CDM 974 RC 78278 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price NM Gastrointestinal Blood Loss Imaging - Report 782781 CDM 974 RC 78278 HCPCS facility both 26 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price NM Gastrointestinal Blood Loss Imaging 782782 CDM 341 RC facility both TC 1927 1927 Gross Charge Type: NIHD_Hosp_Profee_Price NM Gastrointestinal Blood Loss Imaging 782782 CDM 341 RC facility both TC 1927 1927 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Limited 78300 CDM 974 RC facility both TC 189 189 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Limited 78300 CDM 974 RC facility both TC 189 189 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Limited - Report 783001 CDM 974 RC 78300 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Limited - Report 783001 CDM 974 RC 78300 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Multiple Areas - Report 783052 CDM 974 RC 78305 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Multiple Areas - Report 783052 CDM 974 RC 78305 HCPCS facility both 26 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Multiple Areas 783054 CDM 341 RC facility both TC 1613 1613 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Multiple Areas 783054 CDM 341 RC facility both TC 1613 1613 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Whole Body - Report 783061 CDM 974 RC 78306 HCPCS facility both 26 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Whole Body - Report 783061 CDM 974 RC 78306 HCPCS facility both 26 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Whole Body 783062 CDM 341 RC facility both TC 2163 2163 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Imaging Whole Body 783062 CDM 341 RC facility both TC 2163 2163 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Three Phase Study - Report 783151 CDM 974 RC 78315 HCPCS facility both 26 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Three Phase Study - Report 783151 CDM 974 RC 78315 HCPCS facility both 26 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Three Phase Study 783152 CDM 341 RC facility both TC 2498 2498 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Three Phase Study 783152 CDM 341 RC facility both TC 2498 2498 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Single Study 784511 CDM 341 RC facility both TC 4368 4368 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Single Study 784511 CDM 341 RC facility both TC 4368 4368 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Single Study - Report 784512 CDM 974 RC 78451 HCPCS facility both 26 1164 1164 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Single Study - Report 784512 CDM 974 RC 78451 HCPCS facility both 26 1164 1164 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Rest and Stress 784521 CDM 341 RC facility both TC 5814 5814 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Rest and Stress 784521 CDM 341 RC facility both TC 5814 5814 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Rest and Stress - Report 784522 CDM 974 RC 78452 HCPCS facility both 26 1596 1596 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Rest and Stress - Report 784522 CDM 974 RC 78452 HCPCS facility both 26 1596 1596 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Rest and Stress RT 784523 CDM 480 RC facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price NM Myocardial SPECT Rest and Stress RT 784523 CDM 480 RC facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cardiac MUGA - Report 784721 CDM 974 RC 78472 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cardiac MUGA - Report 784721 CDM 974 RC 78472 HCPCS facility both 26 265 265 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cardiac Blood Pool Gated Rest+Stress 784722 CDM 341 RC facility both TC 2126 2126 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cardiac Blood Pool Gated Rest+Stress 784722 CDM 341 RC facility both TC 2126 2126 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cardiac MUGA 784724 CDM 341 RC facility both TC 2126 2126 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cardiac MUGA 784724 CDM 341 RC facility both TC 2126 2126 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Ventilation Imaging 785792 CDM 341 RC facility both TC 1449 1449 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Ventilation Imaging 785792 CDM 341 RC facility both TC 1449 1449 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Ventilation Imaging - Report 785793 CDM 972 RC 78579 HCPCS facility both 26 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Ventilation Imaging - Report 785793 CDM 972 RC 78579 HCPCS facility both 26 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price zzNIHD NM HEART MUSCLE MULTI STUDY 785801 CDM 341 RC facility both TC 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price zzNIHD NM HEART MUSCLE MULTI STUDY 785801 CDM 341 RC facility both TC 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Perfusion Imaging - Report 785802 CDM 974 RC 78580 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Perfusion Imaging - Report 785802 CDM 974 RC 78580 HCPCS facility both 26 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Perfusion Imaging 785803 CDM 341 RC facility both TC 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Perfusion Imaging 785803 CDM 341 RC facility both TC 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Vent/Perf Imaging 785821 CDM 341 RC facility both TC 2367 2367 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Vent/Perf Imaging 785821 CDM 341 RC facility both TC 2367 2367 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Vent/Perf Imaging - Report 785822 CDM 974 RC 78582 HCPCS facility both 26 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price NM Lung Vent/Perf Imaging - Report 785822 CDM 974 RC 78582 HCPCS facility both 26 648 648 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cisternography - Report 786301 CDM 974 RC 78630 HCPCS facility both 26 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cisternography - Report 786301 CDM 974 RC 78630 HCPCS facility both 26 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cisternography 786302 CDM 341 RC facility both TC 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cisternography 786302 CDM 341 RC facility both TC 2184 2184 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cerebrospinal Fluid Leakage Detection - Report 78650 CDM 974 RC 78650 HCPCS facility both 26 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price NM Cerebrospinal Fluid Leakage Detection - Report 78650 CDM 974 RC 78650 HCPCS facility both 26 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price NM Kidney Imaging Single w/ Pharm - Report 787081 CDM 974 RC 78708 HCPCS facility both 26 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price NM Kidney Imaging Single w/ Pharm - Report 787081 CDM 974 RC 78708 HCPCS facility both 26 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price NM Kidney Imaging Single w/ Pharm 787082 CDM 341 RC facility both TC 2289 2289 Gross Charge Type: NIHD_Hosp_Profee_Price NM Kidney Imaging Single w/ Pharm 787082 CDM 341 RC facility both TC 2289 2289 Gross Charge Type: NIHD_Hosp_Profee_Price NM Kidney Morphology w/ Vascular Flow 787091 CDM 341 RC facility both TC 2350 2350 Gross Charge Type: NIHD_Hosp_Profee_Price NM Kidney Morphology w/ Vascular Flow 787091 CDM 341 RC facility both TC 2350 2350 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Spect - Report 788031 CDM 974 RC 78803 HCPCS facility both 26 707 707 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Spect - Report 788031 CDM 974 RC 78803 HCPCS facility both 26 707 707 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Spect 788032 CDM 341 RC facility both TC 2578 2578 Gross Charge Type: NIHD_Hosp_Profee_Price NM Bone Spect 788032 CDM 341 RC facility both TC 2578 2578 Gross Charge Type: NIHD_Hosp_Profee_Price NM Brain Spect 788034 CDM 341 RC facility both TC 2578 2578 Gross Charge Type: NIHD_Hosp_Profee_Price NM Brain Spect 788034 CDM 341 RC facility both TC 2578 2578 Gross Charge Type: NIHD_Hosp_Profee_Price NM Liver Imaging Spect 788036 CDM 341 RC facility both TC 2578 2578 Gross Charge Type: NIHD_Hosp_Profee_Price NM Liver Imaging Spect 788036 CDM 341 RC facility both TC 2578 2578 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT COT PADDED SMALL 7971903 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT COT PADDED SMALL 7971903 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT COT PADDED MEDIUM 7971905 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT COT PADDED MEDIUM 7971905 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT COT PADDED LARGE 7971907 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT COT PADDED LARGE 7971907 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT COT PADDED XLARGE 7971908 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FINGER SPLINT COT PADDED XLARGE 7971908 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FROG SPLINT FINGER SMALL PADDED 7971963 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FROG SPLINT FINGER SMALL PADDED 7971963 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FROG SPLINT FINGER MEDIUM PADDED 7971965 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FROG SPLINT FINGER MEDIUM PADDED 7971965 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FROG SPLINT FINGER LARGE PADDED 7971967 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price FROG SPLINT FINGER LARGE PADDED 7971967 CDM 271 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price STAXX FINGER SPLINT SIZE 3 7972243 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price STAXX FINGER SPLINT SIZE 3 7972243 CDM 274 RC L3927 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price STAXX FINGER SPLINT SIZE 3 7972243 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price STAXX FINGER SPLINT SIZE 3 7972243 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE SUPPORT BUTT HINGED LARGE 7982737 CDM 274 RC L1820 HCPCS facility both 66 66 Gross Charge Type: NIHD_RHC_Price KNEE SUPPORT BUTT HINGED LARGE 7982737 CDM 274 RC L1820 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price KNEE SUPPORT BUTT HINGED LARGE 7982737 CDM 274 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE SUPPORT BUTT HINGED LARGE 7982737 CDM 274 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price WRIST SUPPORT COMFORTFORM RT MED 7987285 CDM 274 RC L3908 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price WRIST SUPPORT COMFORTFORM RT MED 7987285 CDM 274 RC L3908 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price WRIST SUPPORT COMFORTFORM RT MED 7987285 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price WRIST SUPPORT COMFORTFORM RT MED 7987285 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price WRIST SUPPORT COMFORTFORM RT LG 7987287 CDM 274 RC L3908 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price WRIST SUPPORT COMFORTFORM RT LG 7987287 CDM 274 RC L3908 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price WRIST SUPPORT COMFORTFORM RT LG 7987287 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price WRIST SUPPORT COMFORTFORM RT LG 7987287 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB RT/SM 7987303 CDM 274 RC L3908 HCPCS facility both 54 54 Gross Charge Type: NIHD_RHC_Price COMFORTFORM WRIST W/ ABD THUMB RT/SM 7987303 CDM 274 RC L3908 HCPCS facility both 54 54 Gross Charge Type: NIHD_Clinic_Price COMFORTFORM WRIST W/ ABD THUMB RT/SM 7987303 CDM 274 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB RT/SM 7987303 CDM 274 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB RT/MED 7987305 CDM 274 RC L3908 HCPCS facility both 57 57 Gross Charge Type: NIHD_RHC_Price COMFORTFORM WRIST W/ ABD THUMB RT/MED 7987305 CDM 274 RC L3908 HCPCS facility both 57 57 Gross Charge Type: NIHD_Clinic_Price COMFORTFORM WRIST W/ ABD THUMB RT/MED 7987305 CDM 274 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB RT/MED 7987305 CDM 274 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB RT/LG 7987307 CDM 274 RC L3908 HCPCS facility both 61 61 Gross Charge Type: NIHD_RHC_Price COMFORTFORM WRIST W/ ABD THUMB RT/LG 7987307 CDM 274 RC L3908 HCPCS facility both 61 61 Gross Charge Type: NIHD_Clinic_Price COMFORTFORM WRIST W/ ABD THUMB RT/LG 7987307 CDM 274 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB RT/LG 7987307 CDM 274 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB LFT/SM 7987313 CDM 274 RC L3908 HCPCS facility both 54 54 Gross Charge Type: NIHD_RHC_Price COMFORTFORM WRIST W/ ABD THUMB LFT/SM 7987313 CDM 274 RC L3908 HCPCS facility both 54 54 Gross Charge Type: NIHD_Clinic_Price COMFORTFORM WRIST W/ ABD THUMB LFT/SM 7987313 CDM 274 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB LFT/SM 7987313 CDM 274 RC facility both 54 54 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB LFT/MED 7987315 CDM 274 RC L3908 HCPCS facility both 57 57 Gross Charge Type: NIHD_RHC_Price COMFORTFORM WRIST W/ ABD THUMB LFT/MED 7987315 CDM 274 RC L3908 HCPCS facility both 57 57 Gross Charge Type: NIHD_Clinic_Price COMFORTFORM WRIST W/ ABD THUMB LFT/MED 7987315 CDM 274 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB LFT/MED 7987315 CDM 274 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB LFT/LG 7987317 CDM 274 RC L3908 HCPCS facility both 61 61 Gross Charge Type: NIHD_RHC_Price COMFORTFORM WRIST W/ ABD THUMB LFT/LG 7987317 CDM 274 RC L3908 HCPCS facility both 61 61 Gross Charge Type: NIHD_Clinic_Price COMFORTFORM WRIST W/ ABD THUMB LFT/LG 7987317 CDM 274 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price COMFORTFORM WRIST W/ ABD THUMB LFT/LG 7987317 CDM 274 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COCKUP RIGHT 4 1/2 PEDIATRIC XXXS 7987321 CDM 274 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COCKUP RIGHT 4 1/2 PEDIATRIC XXXS 7987321 CDM 274 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COCKUP LEFT 4 1/2 PEDIATRIC XXXS 7987331 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COCKUP LEFT 4 1/2 PEDIATRIC XXXS 7987331 CDM 274 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COCKUP RIGHT 6 PEDIATRIC XXS 87341 7987341 CDM 274 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COCKUP RIGHT 6 PEDIATRIC XXS 87341 7987341 CDM 274 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COCKUP LEFT 6 PEDIATRIC XXS 7987351 CDM 274 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COCKUP LEFT 6 PEDIATRIC XXS 7987351 CDM 274 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price XS PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992852 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_RHC_Price XS PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992852 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price XS PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992852 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price XS PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992852 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price S PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992853 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_RHC_Price S PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992853 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price S PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992853 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price S PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992853 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price M PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992855 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_RHC_Price M PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992855 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price M PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992855 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price M PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992855 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA STABILIZER W/HORSESHOE BUTTRESS 7992857 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_RHC_Price PATELLA STABILIZER W/HORSESHOE BUTTRESS 7992857 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price PATELLA STABILIZER W/HORSESHOE BUTTRESS 7992857 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price PATELLA STABILIZER W/HORSESHOE BUTTRESS 7992857 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price XL PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992858 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_RHC_Price XL PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992858 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price XL PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992858 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price XL PATELLA STABILIZER W/HRSSHOE BUTTRESS 7992858 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price XXL PATELLA STABILIZER W/HRSSHOE BUTTRES 7992859 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_RHC_Price XXL PATELLA STABILIZER W/HRSSHOE BUTTRES 7992859 CDM 274 RC L1812 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price XXL PATELLA STABILIZER W/HRSSHOE BUTTRES 7992859 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price XXL PATELLA STABILIZER W/HRSSHOE BUTTRES 7992859 CDM 274 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COAPTATION SHLDR HUMERAL MED 7997955 CDM 274 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price SPLINT COAPTATION SHLDR HUMERAL MED 7997955 CDM 274 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price CUFF HUMERAL SMALL 7999213 CDM 274 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CUFF HUMERAL SMALL 7999213 CDM 274 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CUFF HUMERAL MEDIUM 7999215 CDM 274 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CUFF HUMERAL MEDIUM 7999215 CDM 274 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CUFF HUMERAL LARGE 7999217 CDM 274 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price CUFF HUMERAL LARGE 7999217 CDM 274 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price ketamine 500 mg/5 mL Inj Sol [INYO] 8000 CDM 42023-0115-10 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy ketamine 100 mg/mL Sol [inyo] 8000 CDM 00409-2051-05 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy ketamine 500 mg/5 mL Inj Sol [INYO] 8000 CDM 00143-9509-10 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy ISOVUE 200M 10ML 8002005 CDM facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price ISOVUE 200M 10ML 8002005 CDM facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROGRAFIN 120ML 8002122 CDM facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price GASTROGRAFIN 120ML 8002122 CDM facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price ISOVUE 300 200ML 8002133 CDM facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price ISOVUE 300 200ML 8002133 CDM facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price ISOVUE 250 150 ML 8003023 CDM facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price ISOVUE 250 150 ML 8003023 CDM facility both 74 74 Gross Charge Type: NIHD_Hosp_Profee_Price ISOVUE 300 150ML 8003045 CDM facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price ISOVUE 300 150ML 8003045 CDM facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price Basic Metabolic Panel 80048 CDM 301 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price Basic Metabolic Panel 80048 CDM 301 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price Electrolyte Panel 80051 CDM 301 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Electrolyte Panel 80051 CDM 301 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Metabolic Panel 800531 CDM 301 RC facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Metabolic Panel 800531 CDM 301 RC facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price "Urine Culture, Routine LC" 800532 CDM 301 RC facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price "Urine Culture, Routine LC" 800532 CDM 301 RC facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price Lipid Cascade w Graph LC 800611 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price Lipid Cascade w Graph LC 800611 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price Lipid Panel w/Direct LDL 800612 CDM 301 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price Lipid Panel w/Direct LDL 800612 CDM 301 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price Renal Function Panel 80069 CDM 301 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price Renal Function Panel 80069 CDM 301 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price Acute Hepatitis LC 80074 CDM 301 RC facility both 15.74 15.74 Gross Charge Type: NIHD_Hosp_Profee_Price Acute Hepatitis LC 80074 CDM 301 RC facility both 15.74 15.74 Gross Charge Type: NIHD_Hosp_Profee_Price Hep Fnct Pnl 80076 CDM 301 RC facility both 148 148 Gross Charge Type: NIHD_Hosp_Profee_Price Hep Fnct Pnl 80076 CDM 301 RC facility both 148 148 Gross Charge Type: NIHD_Hosp_Profee_Price MICRO INTRODUCER 5 FR MPIS-501-U-SST TLS 8008178 CDM 272 RC facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price MICRO INTRODUCER 5 FR MPIS-501-U-SST TLS 8008178 CDM 272 RC facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price bumetanide 1 mg/4 mL Inj Sol [INYO] 8012 CDM 00641-6008-10 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy bumetanide 1 mg/ 4mL Sol [INYO] 8012 CDM 72205-0101-07 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy bumetanide 1 mg/4 mL Inj Sol [INYO] 8012 CDM 70860-0405-04 NDC facility both 4 ML 235 235 Gross Charge Type: Pharmacy bumetanide 1 mg Tab [INYO] 8013 CDM 00904-7016-04 NDC facility both 1 EA 14.61 14.61 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bumetanide 1 mg Tab [inyo] 8013 CDM 00904-7016-06 NDC facility both 1 EA 7.68 7.68 Gross Charge Type: Pharmacy | NDC EA = 1 TAB bumetanide 1 mg Tab [INYO] 8013 CDM 00185-0129-01 NDC facility both 1 EA 6.55 6.55 Gross Charge Type: Pharmacy | NDC EA = 1 TAB polycarbophil 625 mg Tab [INYO] 8015 CDM 00904-2500-91 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Carbamazepine Level 80156 CDM 301 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price Carbamazepine Level 80156 CDM 301 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price "Carbamazepine, Free, Serum LC" 80157 CDM 301 RC facility both 18.73 18.73 Gross Charge Type: NIHD_Hosp_Profee_Price "Carbamazepine, Free, Serum LC" 80157 CDM 301 RC facility both 18.73 18.73 Gross Charge Type: NIHD_Hosp_Profee_Price "Cyclosporine, Blood LC-MS/MS LC" 80158 CDM 301 RC facility both 12.14 12.14 Gross Charge Type: NIHD_Hosp_Profee_Price "Cyclosporine, Blood LC-MS/MS LC" 80158 CDM 301 RC facility both 12.14 12.14 Gross Charge Type: NIHD_Hosp_Profee_Price Digoxin Level 80162 CDM 301 RC facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price Digoxin Level 80162 CDM 301 RC facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price Valproic Acid 80164 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price Valproic Acid 80164 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price Free Valproic Acid (Depakote) LC 80165 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price Free Valproic Acid (Depakote) LC 80165 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price Gentamicin Level 801701 CDM 301 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price Gentamicin Level 801701 CDM 301 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price Gentamicin Level Peak 801702 CDM 301 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price Gentamicin Level Peak 801702 CDM 301 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price Gentamicin Level Trough 801703 CDM 301 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price Gentamicin Level Trough 801703 CDM 301 RC facility both 663 663 Gross Charge Type: NIHD_Hosp_Profee_Price "Lamotrigine (Lamictal), Serum LC" 80175 CDM 301 RC facility both 8.96 8.96 Gross Charge Type: NIHD_Hosp_Profee_Price "Lamotrigine (Lamictal), Serum LC" 80175 CDM 301 RC facility both 8.96 8.96 Gross Charge Type: NIHD_Hosp_Profee_Price "Levetiracetam (Keppra), S LC" 80177 CDM 301 RC facility both 10.59 10.59 Gross Charge Type: NIHD_Hosp_Profee_Price "Levetiracetam (Keppra), S LC" 80177 CDM 301 RC facility both 10.59 10.59 Gross Charge Type: NIHD_Hosp_Profee_Price Lithium Level 801781 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price Lithium Level 801781 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "Oxcarbazepine (Trileptal),S LC" 801782 CDM 301 RC facility both 6.52 6.52 Gross Charge Type: NIHD_Hosp_Profee_Price "Oxcarbazepine (Trileptal),S LC" 801782 CDM 301 RC facility both 6.52 6.52 Gross Charge Type: NIHD_Hosp_Profee_Price Mycophenolic Acid and Metabo. LC 80180 CDM 301 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Mycophenolic Acid and Metabo. LC 80180 CDM 301 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Butalbital LC 801841 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Butalbital LC 801841 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Phenobarbital Level 801842 CDM 301 RC facility both 332 332 Gross Charge Type: NIHD_Hosp_Profee_Price Phenobarbital Level 801842 CDM 301 RC facility both 332 332 Gross Charge Type: NIHD_Hosp_Profee_Price Phenytoin Level Total 80185 CDM 301 RC facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price Phenytoin Level Total 80185 CDM 301 RC facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price "Sirolimus (Rapamune), Blood LC" 80195 CDM 301 RC facility both 16.86 16.86 Gross Charge Type: NIHD_Hosp_Profee_Price "Sirolimus (Rapamune), Blood LC" 80195 CDM 301 RC facility both 16.86 16.86 Gross Charge Type: NIHD_Hosp_Profee_Price "Tacrolimus (FK506), Blood LC/MS LC" 80197 CDM 301 RC facility both 27.5 27.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Tacrolimus (FK506), Blood LC/MS LC" 80197 CDM 301 RC facility both 27.5 27.5 Gross Charge Type: NIHD_Hosp_Profee_Price Tacrolimus by Immunoassay LC 801977 CDM 301 RC facility both 32.58 32.58 Gross Charge Type: NIHD_Hosp_Profee_Price Tacrolimus by Immunoassay LC 801977 CDM 301 RC facility both 32.58 32.58 Gross Charge Type: NIHD_Hosp_Profee_Price Theophylline LC 80198 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price Theophylline LC 80198 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price Tobramycin Level 802001 CDM 301 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price Tobramycin Level 802001 CDM 301 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price Tobramycin Level Peak 802002 CDM 301 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price Tobramycin Level Peak 802002 CDM 301 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price Tobramycin Level Trough 802003 CDM 301 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price Tobramycin Level Trough 802003 CDM 301 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price Vancomycin Level 802021 CDM 301 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price Vancomycin Level 802021 CDM 301 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price Vancomycin Level Peak 802022 CDM 301 RC facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price Vancomycin Level Peak 802022 CDM 301 RC facility both 451 451 Gross Charge Type: NIHD_Hosp_Profee_Price Vancomycin Trough LC 802023_1 CDM 301 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Vancomycin Trough LC 802023_1 CDM 301 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Vancomycin Level Trough 802023_2 CDM 301 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price Vancomycin Level Trough 802023_2 CDM 301 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price Lacosamide LC 80235 CDM 300 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Lacosamide LC 80235 CDM 300 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Acetaminophen Level 802991 CDM 301 RC facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price Acetaminophen Level 802991 CDM 301 RC facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price Chlordiazepoxide LC 802992 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Chlordiazepoxide LC 802992 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Ketones Serum 802993 CDM 301 RC facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price Ketones Serum 802993 CDM 301 RC facility both 687 687 Gross Charge Type: NIHD_Hosp_Profee_Price Thiopurine Metabolites LC 802994 CDM 301 RC facility both 95 95 Gross Charge Type: NIHD_Hosp_Profee_Price Thiopurine Metabolites LC 802994 CDM 301 RC facility both 95 95 Gross Charge Type: NIHD_Hosp_Profee_Price Salicylate Level 802995 CDM 301 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price Salicylate Level 802995 CDM 301 RC facility both 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price Drug Screen Urine POCT 80305 CDM 80305 HCPCS facility both 128 128 Gross Charge Type: NIHD_RHC_Price Drug Screen Urine POCT 80305 CDM 80305 HCPCS facility both 128 128 Gross Charge Type: NIHD_Clinic_Price Drug Screen Urine POCT 80305 CDM 300 RC facility both 128 128 Gross Charge Type: NIHD_Hosp_Profee_Price Drug Screen Urine POCT 80305 CDM 300 RC facility both 128 128 Gross Charge Type: NIHD_Hosp_Profee_Price 12+Oxycodone+Crt-Unbund LC 803071 CDM 300 RC facility both 46.14 46.14 Gross Charge Type: NIHD_Hosp_Profee_Price 12+Oxycodone+Crt-Unbund LC 803071 CDM 300 RC facility both 46.14 46.14 Gross Charge Type: NIHD_Hosp_Profee_Price 733692 9+Oxycodone+Crt-Scr LC 803072 CDM 300 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price 733692 9+Oxycodone+Crt-Scr LC 803072 CDM 300 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price Drug Screen Urine 803073 CDM 301 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price Drug Screen Urine 803073 CDM 301 RC facility both 730 730 Gross Charge Type: NIHD_Hosp_Profee_Price MAT Drug Screen LC 803074 CDM 300 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price MAT Drug Screen LC 803074 CDM 300 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price ToxAssure 13 Summary LC 803075 CDM 80307 HCPCS facility both 50 50 Gross Charge Type: NIHD_Clinic_Price ToxAssure 13 Summary LC 803075 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price ToxAssure 13 Summary LC 803075 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price ToxAssure PDF LC 803076 CDM 80307 HCPCS facility both 50 50 Gross Charge Type: NIHD_Clinic_Price ToxAssure PDF LC 803076 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price ToxAssure PDF LC 803076 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Acetone LC 803201 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Acetone LC 803201 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Alcohol Level 803202 CDM 301 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price Alcohol Level 803202 CDM 301 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price .Alcohol Biomarkers-Confirm LC 80321 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Alcohol Biomarkers-Confirm LC 80321 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price Amph Conf LC 80324 CDM 300 RC facility both 59.75 59.75 Gross Charge Type: NIHD_Hosp_Profee_Price Amph Conf LC 80324 CDM 300 RC facility both 59.75 59.75 Gross Charge Type: NIHD_Hosp_Profee_Price .Amphetamine GC/MS Ur LC 803241 CDM 300 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price .Amphetamine GC/MS Ur LC 803241 CDM 300 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price "Ferritin, Serum LC" 80327 CDM 301 RC facility both 77.52 77.52 Gross Charge Type: NIHD_Hosp_Profee_Price "Ferritin, Serum LC" 80327 CDM 301 RC facility both 77.52 77.52 Gross Charge Type: NIHD_Hosp_Profee_Price "Desipramine, Serum LC" 80335 CDM 301 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price "Desipramine, Serum LC" 80335 CDM 301 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Aripiprazole LC 80342 CDM 301 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Aripiprazole LC 80342 CDM 301 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price "Quetiapine, Serum or Plasma 808404 LC" 803421 CDM 301 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price "Quetiapine, Serum or Plasma 808404 LC" 803421 CDM 301 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price .Barbiturate GCMS Ur LC 803451 CDM 301 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price .Barbiturate GCMS Ur LC 803451 CDM 301 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price .Barbiturates -Confirm LC 803452 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Barbiturates -Confirm LC 803452 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price Diazepam LC 803453 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Diazepam LC 803453 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price .Benzodiazepines Conf Ur LC 803461 CDM 301 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price .Benzodiazepines Conf Ur LC 803461 CDM 301 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price .Expanded Benzo-Confirm LC 803462 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Expanded Benzo-Confirm LC 803462 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price Phenobarbital LC 803463 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Phenobarbital LC 803463 CDM 301 RC facility both 2.93 2.93 Gross Charge Type: NIHD_Hosp_Profee_Price Buprenorphine/CR LC 80348 CDM 300 RC facility both 35 35 Gross Charge Type: NIHD_Hosp_Profee_Price Buprenorphine/CR LC 80348 CDM 300 RC facility both 35 35 Gross Charge Type: NIHD_Hosp_Profee_Price .Carboxy-Thc Normalized Ratio LC 80349 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Carboxy-Thc Normalized Ratio LC 80349 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Cannabinoid GCMS Ur LC 803491 CDM 301 RC facility both 12.74 12.74 Gross Charge Type: NIHD_Hosp_Profee_Price .Cannabinoid GCMS Ur LC 803491 CDM 301 RC facility both 12.74 12.74 Gross Charge Type: NIHD_Hosp_Profee_Price .Cocaine GCMS LC 80353 CDM 301 RC facility both 12.74 12.74 Gross Charge Type: NIHD_Hosp_Profee_Price .Cocaine GCMS LC 80353 CDM 301 RC facility both 12.74 12.74 Gross Charge Type: NIHD_Hosp_Profee_Price .Benzoylecgonine-Confirm LC 803531 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Benzoylecgonine-Confirm LC 803531 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Fentanyl-Confirm LC 80354 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Fentanyl-Confirm LC 80354 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Fentanyl/Norfentanyl Conf Ur LC 803541 CDM 301 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price .Fentanyl/Norfentanyl Conf Ur LC 803541 CDM 301 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price .6-Acetylmorphine-Confirm LC 80356 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .6-Acetylmorphine-Confirm LC 80356 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Methadone-Confirm LC 80358 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Methadone-Confirm LC 80358 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price ".Methadone (GC/MS), Urine LC" 803581 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price ".Methadone (GC/MS), Urine LC" 803581 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price MDMA Conf LC 80359 CDM 301 RC facility both 59.75 59.75 Gross Charge Type: NIHD_Hosp_Profee_Price MDMA Conf LC 80359 CDM 301 RC facility both 59.75 59.75 Gross Charge Type: NIHD_Hosp_Profee_Price ".Opiates Confirmation, Urine LC" 80361 CDM 301 RC facility both 13.85 13.85 Gross Charge Type: NIHD_Hosp_Profee_Price ".Opiates Confirmation, Urine LC" 80361 CDM 301 RC facility both 13.85 13.85 Gross Charge Type: NIHD_Hosp_Profee_Price .Expanded Opiate-Confirm LC 803611 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Expanded Opiate-Confirm LC 803611 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price Naloxone LC 80362 CDM 301 RC facility both 17.5 17.5 Gross Charge Type: NIHD_Hosp_Profee_Price Naloxone LC 80362 CDM 301 RC facility both 17.5 17.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Meper/Normep GCMS Ur LC 803621 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Meper/Normep GCMS Ur LC 803621 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Oxycodone/Oxymorphone Confirm LC 80365 CDM 300 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price .Oxycodone/Oxymorphone Confirm LC 80365 CDM 300 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price .Oxycodone-Confirm LC 803651 CDM 300 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Oxycodone-Confirm LC 803651 CDM 300 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Propoxyphene-Confirm LC 80367 CDM 301 RC facility both 12.2 12.2 Gross Charge Type: NIHD_Hosp_Profee_Price .Propoxyphene-Confirm LC 80367 CDM 301 RC facility both 12.2 12.2 Gross Charge Type: NIHD_Hosp_Profee_Price ".Propoxyphene (GC/MS), Urine LC" 803671 CDM 301 RC facility both 12.2 12.2 Gross Charge Type: NIHD_Hosp_Profee_Price ".Propoxyphene (GC/MS), Urine LC" 803671 CDM 301 RC facility both 12.2 12.2 Gross Charge Type: NIHD_Hosp_Profee_Price .Carisoprodol-Confirm LC 80369 CDM 301 RC facility both 15.66 15.66 Gross Charge Type: NIHD_Hosp_Profee_Price .Carisoprodol-Confirm LC 80369 CDM 301 RC facility both 15.66 15.66 Gross Charge Type: NIHD_Hosp_Profee_Price .Tapentadol-Confirm LC 80372 CDM 301 RC facility both 12.2 12.2 Gross Charge Type: NIHD_Hosp_Profee_Price .Tapentadol-Confirm LC 80372 CDM 301 RC facility both 12.2 12.2 Gross Charge Type: NIHD_Hosp_Profee_Price .Tramadol-Confirm LC 80373 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Tramadol-Confirm LC 80373 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Tramadol GCMS Ur LC 803731 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price .Tramadol GCMS Ur LC 803731 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Foreign Body Removal 8050338 CDM 360 RC facility both 5665 5665 Gross Charge Type: NIHD_Hosp_Profee_Price Foreign Body Removal 8050338 CDM 360 RC facility both 5665 5665 Gross Charge Type: NIHD_Hosp_Profee_Price Frenulectomy 8050339 CDM 360 RC facility both 1894 1894 Gross Charge Type: NIHD_Hosp_Profee_Price Frenulectomy 8050339 CDM 360 RC facility both 1894 1894 Gross Charge Type: NIHD_Hosp_Profee_Price RT Incentive Spirometry Initial CHARGE 8078345 CDM 270 RC facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price RT Incentive Spirometry Initial CHARGE 8078345 CDM 270 RC facility both 367 367 Gross Charge Type: NIHD_Hosp_Profee_Price RT Vapotherm Initial CHARGE 8078364 CDM 271 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price RT Vapotherm Initial CHARGE 8078364 CDM 271 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price RT Oxygen Hours CHARGE 8078404 CDM 270 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price RT Oxygen Hours CHARGE 8078404 CDM 270 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Obstetrics 8078889 CDM 122 RC facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Obstetrics 8078889 CDM 122 RC facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price EVIVA NEEDLE GUIDE FOR 9G 8090000 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price EVIVA NEEDLE GUIDE FOR 9G 8090000 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price EVIVA BIOPSY DEVICE9G X 13CM 12MM FISCHE 8091312 CDM facility both 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price EVIVA BIOPSY DEVICE9G X 13CM 12MM FISCHE 8091312 CDM facility both 466 466 Gross Charge Type: NIHD_Hosp_Profee_Price EVIVA BIOPSY DEVICE9G X 13CM 20MM 8091320 CDM facility both 582 582 Gross Charge Type: NIHD_Hosp_Profee_Price EVIVA BIOPSY DEVICE9G X 13CM 20MM 8091320 CDM facility both 582 582 Gross Charge Type: NIHD_Hosp_Profee_Price Urinalysis Complete with Culture if Indicated 81001 CDM 307 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price Urinalysis Complete with Culture if Indicated 81001 CDM 307 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price .Urinalysis POCT 810021 CDM 307 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price .Urinalysis POCT 810021 CDM 307 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price UA Protein POCT 810022 CDM 304 RC facility both 35 35 Gross Charge Type: NIHD_Hosp_Profee_Price UA Protein POCT 810022 CDM 304 RC facility both 35 35 Gross Charge Type: NIHD_Hosp_Profee_Price UA Specific Gravity POCT 810023 CDM 307 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price UA Specific Gravity POCT 810023 CDM 307 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price Document in POC Result Entry 810024 CDM 307 RC facility both 35 35 Gross Charge Type: NIHD_Hosp_Profee_Price Document in POC Result Entry 810024 CDM 307 RC facility both 35 35 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Dipstick Clinic POC (RE) 810025 CDM 300 RC 81002 HCPCS facility both 35 35 Gross Charge Type: NIHD_RHC_Price Urine Dipstick Clinic POC (RE) 810025 CDM 300 RC 81002 HCPCS facility both 35 35 Gross Charge Type: NIHD_Clinic_Price Drug Screen Clinic POC (RE) 810026 CDM 300 RC 81002 HCPCS facility both 35 35 Gross Charge Type: NIHD_RHC_Price Drug Screen Clinic POC (RE) 810026 CDM 300 RC 81002 HCPCS facility both 35 35 Gross Charge Type: NIHD_Clinic_Price "Phosphorus, U LC" 81003 CDM 307 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price "Phosphorus, U LC" 81003 CDM 307 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price UA w Culture if Ind 810031 CDM 307 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price UA w Culture if Ind 810031 CDM 307 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price Urinalysis Dipstick 810032 CDM 81003 HCPCS facility both 82 82 Gross Charge Type: NIHD_RHC_Price Urinalysis Dipstick 810032 CDM 307 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price Urinalysis Dipstick 810032 CDM 307 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price UA Micro 810151 CDM 307 RC facility both 36 36 Gross Charge Type: NIHD_Hosp_Profee_Price UA Micro 810151 CDM 307 RC facility both 36 36 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Sediment Microscopy POCT 810152 CDM 521 RC 81015 HCPCS facility both 30 30 Gross Charge Type: NIHD_RHC_Price Urine Sediment Microscopy POCT 810152 CDM 521 RC 81015 HCPCS facility both 30 30 Gross Charge Type: NIHD_Clinic_Price Urine Sediment Microscopy POCT 810152 CDM 300 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Sediment Microscopy POCT 810152 CDM 300 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price Urinalysis POC (RE) 810153 CDM 81015 HCPCS facility both 42 42 Gross Charge Type: NIHD_Clinic_Price Urinalysis POC (RE) 810153 CDM 300 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Urinalysis POC (RE) 810153 CDM 300 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Pregnancy Test Clinic POC (RE) 810251 CDM 81025 HCPCS facility both 112 112 Gross Charge Type: NIHD_RHC_Price Urine Pregnancy Test Clinic POC (RE) 810251 CDM 81025 HCPCS facility both 112 112 Gross Charge Type: NIHD_Clinic_Price Pregnancy Test Urine Qual 810252 CDM 307 RC facility both 319 319 Gross Charge Type: NIHD_Hosp_Profee_Price Pregnancy Test Urine Qual 810252 CDM 307 RC facility both 319 319 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Pregnancy Qual POCT 810253 CDM 301 RC facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Pregnancy Qual POCT 810253 CDM 301 RC facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price e13a2 (b2a2) transcript LC 81206 CDM 310 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price e13a2 (b2a2) transcript LC 81206 CDM 310 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price e14a2 (b3a2) transcript LC 81207 CDM 310 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price e14a2 (b3a2) transcript LC 81207 CDM 310 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Cystic Fibrosis Profile LC 81220 CDM 310 RC facility both 57.02 57.02 Gross Charge Type: NIHD_Hosp_Profee_Price Cystic Fibrosis Profile LC 81220 CDM 310 RC facility both 57.02 57.02 Gross Charge Type: NIHD_Hosp_Profee_Price Cystic Fibrosis 97 Variants LC 812201 CDM 301 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price Cystic Fibrosis 97 Variants LC 812201 CDM 301 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price .Microarray 511037 LC 81229 CDM 310 RC facility both 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price .Microarray 511037 LC 81229 CDM 310 RC facility both 890 890 Gross Charge Type: NIHD_Hosp_Profee_Price "Factor II, DNA Analysis LC" 81240 CDM 310 RC facility both 27.51 27.51 Gross Charge Type: NIHD_Hosp_Profee_Price "Factor II, DNA Analysis LC" 81240 CDM 310 RC facility both 27.51 27.51 Gross Charge Type: NIHD_Hosp_Profee_Price .Factor V Leiden Mutation LC 81241 CDM 300 RC facility both 34.28 34.28 Gross Charge Type: NIHD_Hosp_Profee_Price .Factor V Leiden Mutation LC 81241 CDM 300 RC facility both 34.28 34.28 Gross Charge Type: NIHD_Hosp_Profee_Price Factor V Leiden Mutation LC 812411 CDM 300 RC facility both 34.28 34.28 Gross Charge Type: NIHD_Hosp_Profee_Price Factor V Leiden Mutation LC 812411 CDM 300 RC facility both 34.28 34.28 Gross Charge Type: NIHD_Hosp_Profee_Price "Hered.Hemochromatosis, DNA LC" 81256 CDM 310 RC facility both 61.09 61.09 Gross Charge Type: NIHD_Hosp_Profee_Price "Hered.Hemochromatosis, DNA LC" 81256 CDM 310 RC facility both 61.09 61.09 Gross Charge Type: NIHD_Hosp_Profee_Price "JAK2 Mutation Analysis, Qual LC" 81270 CDM 310 RC facility both 107.92 107.92 Gross Charge Type: NIHD_Hosp_Profee_Price "JAK2 Mutation Analysis, Qual LC" 81270 CDM 310 RC facility both 107.92 107.92 Gross Charge Type: NIHD_Hosp_Profee_Price MTHFR LC 81291 CDM 300 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price MTHFR LC 81291 CDM 300 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price EVIVA SMARK BIOPSY SITE IDENTIFIER FOR U 8132500 CDM facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price EVIVA SMARK BIOPSY SITE IDENTIFIER FOR U 8132500 CDM facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price Spinal Muscular Atrophy (SMA) LC 81329 CDM 310 RC facility both 135 135 Gross Charge Type: NIHD_Hosp_Profee_Price Spinal Muscular Atrophy (SMA) LC 81329 CDM 310 RC facility both 135 135 Gross Charge Type: NIHD_Hosp_Profee_Price HLA B 27 Disease Association LC 81374 CDM 310 RC facility both 18.75 18.75 Gross Charge Type: NIHD_Hosp_Profee_Price HLA B 27 Disease Association LC 81374 CDM 310 RC facility both 18.75 18.75 Gross Charge Type: NIHD_Hosp_Profee_Price APOE Alzheimer's Risk LC 504040 81401 CDM 300 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price APOE Alzheimer's Risk LC 504040 81401 CDM 300 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price HCV FibroSure LC 81596 CDM 300 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price HCV FibroSure LC 81596 CDM 300 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price "ACTH, Plasma LC" 82024 CDM 301 RC facility both 5.75 5.75 Gross Charge Type: NIHD_Hosp_Profee_Price "ACTH, Plasma LC" 82024 CDM 301 RC facility both 5.75 5.75 Gross Charge Type: NIHD_Hosp_Profee_Price Albumin Level 82040 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Albumin Level 82040 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price "Albumin, Body Fluid LC" 82042 CDM 301 RC facility both 2.6 2.6 Gross Charge Type: NIHD_Hosp_Profee_Price "Albumin, Body Fluid LC" 82042 CDM 301 RC facility both 2.6 2.6 Gross Charge Type: NIHD_Hosp_Profee_Price "Albumin, Random Urine LC" 82043 CDM 300 RC facility both 22.81 22.81 Gross Charge Type: NIHD_Hosp_Profee_Price "Albumin, Random Urine LC" 82043 CDM 300 RC facility both 22.81 22.81 Gross Charge Type: NIHD_Hosp_Profee_Price Microalbumin Level 24 Hour Urine 820431 CDM 301 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price Microalbumin Level 24 Hour Urine 820431 CDM 301 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price Microalbumin Level Urine 820432 CDM 301 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price Microalbumin Level Urine 820432 CDM 301 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Microalbumin 82044 CDM 301 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Microalbumin 82044 CDM 301 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Breath Alcohol Test 820751 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Breath Alcohol Test 820751 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Breath Alcohol 820752 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Breath Alcohol 820752 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Aldosterone LC 82088 CDM 301 RC facility both 4.23 4.23 Gross Charge Type: NIHD_Hosp_Profee_Price Aldosterone LC 82088 CDM 301 RC facility both 4.23 4.23 Gross Charge Type: NIHD_Hosp_Profee_Price A-1-Antitrypsin LC 821031 CDM 301 RC facility both 7.26 7.26 Gross Charge Type: NIHD_Hosp_Profee_Price A-1-Antitrypsin LC 821031 CDM 301 RC facility both 7.26 7.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Alpha-1-Antitrypsin, Serum LC" 821032 CDM 301 RC facility both 4.5 4.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Alpha-1-Antitrypsin, Serum LC" 821032 CDM 301 RC facility both 4.5 4.5 Gross Charge Type: NIHD_Hosp_Profee_Price Phenotype (PI) LC 82104 CDM 301 RC facility both 7.25 7.25 Gross Charge Type: NIHD_Hosp_Profee_Price Phenotype (PI) LC 82104 CDM 301 RC facility both 7.25 7.25 Gross Charge Type: NIHD_Hosp_Profee_Price "AFP, Serum, Tumor Marker LC" 82105 CDM 301 RC facility both 4.07 4.07 Gross Charge Type: NIHD_Hosp_Profee_Price "AFP, Serum, Tumor Marker LC" 82105 CDM 301 RC facility both 4.07 4.07 Gross Charge Type: NIHD_Hosp_Profee_Price AFP with AFP-L3% LC 82107 CDM 301 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price AFP with AFP-L3% LC 82107 CDM 301 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price U24 Volume (Preservative) LC 82131 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price U24 Volume (Preservative) LC 82131 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Phosphorus U24 LC 82140 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Phosphorus U24 LC 82140 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Ammonia LC 821401 CDM 301 RC facility both 18.97 18.97 Gross Charge Type: NIHD_Hosp_Profee_Price Ammonia LC 821401 CDM 301 RC facility both 18.97 18.97 Gross Charge Type: NIHD_Hosp_Profee_Price Ammonia Level 821402 CDM 301 RC facility both 544 544 Gross Charge Type: NIHD_Hosp_Profee_Price Ammonia Level 821402 CDM 301 RC facility both 544 544 Gross Charge Type: NIHD_Hosp_Profee_Price Amylase LC 8215011 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price Amylase LC 8215011 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price Amylase Level 8215012 CDM 301 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price Amylase Level 8215012 CDM 301 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price "Amylase, Body Fluid LC" 821502 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price "Amylase, Body Fluid LC" 821502 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price Androstenedione LCMS LC 82157 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price Androstenedione LCMS LC 82157 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price Angiotensin-Converting Enzyme LC 82164 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price Angiotensin-Converting Enzyme LC 82164 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price NASH FibroSure Plus LC 82172 CDM 300 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price NASH FibroSure Plus LC 82172 CDM 300 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price "Cadmium, Blood LC" 82175 CDM 301 RC facility both 13.05 13.05 Gross Charge Type: NIHD_Hosp_Profee_Price "Cadmium, Blood LC" 82175 CDM 301 RC facility both 13.05 13.05 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Swingbed-Skilled 8223046 CDM 110 RC facility both 1344 1344 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Swingbed-Skilled 8223046 CDM 110 RC facility both 1344 1344 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Microglobulin, Serum LC" 82232 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Microglobulin, Serum LC" 82232 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price Pterygium 8223891 CDM 360 RC facility both 7628 7628 Gross Charge Type: NIHD_Hosp_Profee_Price Pterygium 8223891 CDM 360 RC facility both 7628 7628 Gross Charge Type: NIHD_Hosp_Profee_Price Bile Acids LC 82239 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price Bile Acids LC 82239 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price Neonatal Bilirubin 82247 CDM 301 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price Neonatal Bilirubin 82247 CDM 301 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price Bilirubin Neonatal 822471 CDM 301 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price Bilirubin Neonatal 822471 CDM 301 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price Bilirubin Total 822472 CDM 301 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price Bilirubin Total 822472 CDM 301 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price Bili Dir 82248 CDM 301 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price Bili Dir 82248 CDM 301 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price Fructosamine LC 82253 CDM 301 RC facility both 4.5 4.5 Gross Charge Type: NIHD_Hosp_Profee_Price Fructosamine LC 82253 CDM 301 RC facility both 4.5 4.5 Gross Charge Type: NIHD_Hosp_Profee_Price Gastric Occult Blood 822711 CDM 301 RC facility both 86 86 Gross Charge Type: NIHD_Hosp_Profee_Price Gastric Occult Blood 822711 CDM 301 RC facility both 86 86 Gross Charge Type: NIHD_Hosp_Profee_Price Occult Blood Gastric Fluid 822712 CDM 301 RC facility both 86 86 Gross Charge Type: NIHD_Hosp_Profee_Price Occult Blood Gastric Fluid 822712 CDM 301 RC facility both 86 86 Gross Charge Type: NIHD_Hosp_Profee_Price Fecal Occult Blood (Guaiac FOB) 822721 CDM 301 RC facility both 123 123 Gross Charge Type: NIHD_Hosp_Profee_Price Fecal Occult Blood (Guaiac FOB) 822721 CDM 301 RC facility both 123 123 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only POCT Fecal Occult Blood (Guaiac) 822722 CDM 521 RC 82272 HCPCS facility both 53 53 Gross Charge Type: NIHD_Clinic_Price Occult Blood Diagnostic 1st Spec 822723 CDM 301 RC facility both 123 123 Gross Charge Type: NIHD_Hosp_Profee_Price Occult Blood Diagnostic 1st Spec 822723 CDM 301 RC facility both 123 123 Gross Charge Type: NIHD_Hosp_Profee_Price 82272 Diagnostic Stool Occult Blood 822724 CDM 300 RC 82272 HCPCS facility both 51 51 Gross Charge Type: NIHD_RHC_Price 82272 Diagnostic Stool Occult Blood 822724 CDM 300 RC 82272 HCPCS facility both 53 53 Gross Charge Type: NIHD_Clinic_Price Fecal Occult Blood (iFOBT) POCT 82274 CDM 521 RC 82274 HCPCS facility both 91 91 Gross Charge Type: NIHD_RHC_Price Fecal Occult Blood (iFOBT) POCT 82274 CDM 521 RC 82274 HCPCS facility both 91 91 Gross Charge Type: NIHD_Clinic_Price Fecal Occult Blood (iFOBT) POCT 82274 CDM 300 RC facility both 91 91 Gross Charge Type: NIHD_Hosp_Profee_Price Fecal Occult Blood (iFOBT) POCT 82274 CDM 300 RC facility both 91 91 Gross Charge Type: NIHD_Hosp_Profee_Price pH Gastric 82282 CDM 301 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price pH Gastric 82282 CDM 301 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price Arsenic LC 82300 CDM 301 RC facility both 13.05 13.05 Gross Charge Type: NIHD_Hosp_Profee_Price Arsenic LC 82300 CDM 301 RC facility both 13.05 13.05 Gross Charge Type: NIHD_Hosp_Profee_Price 25-Hydroxyvitamin D LCMS D2+D3 LC 8230611 CDM 301 RC facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price 25-Hydroxyvitamin D LCMS D2+D3 LC 8230611 CDM 301 RC facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin D 25 Hydroxy Level 8230612 CDM 301 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin D 25 Hydroxy Level 8230612 CDM 301 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin D, 25-Hydroxy LC" 823062 CDM 301 RC facility both 7.95 7.95 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin D, 25-Hydroxy LC" 823062 CDM 301 RC facility both 7.95 7.95 Gross Charge Type: NIHD_Hosp_Profee_Price Calcium Level Total 82310 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Calcium Level Total 82310 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Calcium LC 823101 CDM 301 RC facility both 4.02 4.02 Gross Charge Type: NIHD_Hosp_Profee_Price Calcium LC 823101 CDM 301 RC facility both 4.02 4.02 Gross Charge Type: NIHD_Hosp_Profee_Price Calcium U 24 LC 823401 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Calcium U 24 LC 823401 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcium, 24Hr Urine LC" 823402 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcium, 24Hr Urine LC" 823402 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price Calcium Ur LC 823403 CDM 301 RC facility both 3.88 3.88 Gross Charge Type: NIHD_Hosp_Profee_Price Calcium Ur LC 823403 CDM 301 RC facility both 3.88 3.88 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcium, Random Urine LC" 823404 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcium, Random Urine LC" 823404 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price "Calculi, Urinary, with Photo LC" 82365 CDM 300 RC facility both 11.05 11.05 Gross Charge Type: NIHD_Hosp_Profee_Price "Calculi, Urinary, with Photo LC" 82365 CDM 300 RC facility both 11.05 11.05 Gross Charge Type: NIHD_Hosp_Profee_Price "Carbamazepine(Tegretol),S LC" 82372 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price "Carbamazepine(Tegretol),S LC" 82372 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price Carbon Dioxide Level 82374 CDM 301 RC facility both 56 56 Gross Charge Type: NIHD_Hosp_Profee_Price Carbon Dioxide Level 82374 CDM 301 RC facility both 56 56 Gross Charge Type: NIHD_Hosp_Profee_Price Carboxyhemoglobin Arterial 823751 CDM 301 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price Carboxyhemoglobin Arterial 823751 CDM 301 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price Carboxyhemoglobin Cap 823752 CDM 301 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price Carboxyhemoglobin Cap 823752 CDM 301 RC facility both 613 613 Gross Charge Type: NIHD_Hosp_Profee_Price CEA LC 82378 CDM 301 RC facility both 3.46 3.46 Gross Charge Type: NIHD_Hosp_Profee_Price CEA LC 82378 CDM 301 RC facility both 3.46 3.46 Gross Charge Type: NIHD_Hosp_Profee_Price "Catecholamines,Ur.,Free,24 Hr LC" 82384 CDM 301 RC facility both 16.09 16.09 Gross Charge Type: NIHD_Hosp_Profee_Price "Catecholamines,Ur.,Free,24 Hr LC" 82384 CDM 301 RC facility both 16.09 16.09 Gross Charge Type: NIHD_Hosp_Profee_Price "Catecholamines, Plasma LC" 823841 CDM 301 RC facility both 6.95 6.95 Gross Charge Type: NIHD_Hosp_Profee_Price "Catecholamines, Plasma LC" 823841 CDM 301 RC facility both 6.95 6.95 Gross Charge Type: NIHD_Hosp_Profee_Price PTHrP (PTH-Related Peptide) LC 82397 CDM 301 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price PTHrP (PTH-Related Peptide) LC 82397 CDM 301 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Mullerian Hormone (AMH) LC 823971 CDM 301 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Mullerian Hormone (AMH) LC 823971 CDM 301 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price 82397 Infliximab and Anti-Infliximab Antibody 823972 CDM 301 RC 82397 HCPCS facility both 189 189 Gross Charge Type: NIHD_Hosp_Profee_Price 82397 Infliximab and Anti-Infliximab Antibody 823972 CDM 301 RC 82397 HCPCS facility both 189 189 Gross Charge Type: NIHD_Hosp_Profee_Price Chloride Level 82435 CDM 300 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price Chloride Level 82435 CDM 300 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price U24 Volume LC 82436 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price U24 Volume LC 82436 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Cholesterol Total 82465 CDM 301 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price Cholesterol Total 82465 CDM 301 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price "Complement, Total (CH50) LC" 82491 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Complement, Total (CH50) LC" 82491 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Citric Acid (Citrate), 24-Hour Urine LC" 825071 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "Citric Acid (Citrate), 24-Hour Urine LC" 825071 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Urine 24 LC 825072 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Urine 24 LC 825072 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price N-telopeptide LC 825231 CDM 301 RC facility both 8.14 8.14 Gross Charge Type: NIHD_Hosp_Profee_Price N-telopeptide LC 825231 CDM 301 RC facility both 8.14 8.14 Gross Charge Type: NIHD_Hosp_Profee_Price "Copper, Serum LC" 82525 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Copper, Serum LC" 82525 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Cortisol, Urinary Free LC" 82530 CDM 301 RC facility both 10.41 10.41 Gross Charge Type: NIHD_Hosp_Profee_Price "Cortisol, Urinary Free LC" 82530 CDM 301 RC facility both 10.41 10.41 Gross Charge Type: NIHD_Hosp_Profee_Price Cort Bind Glob LC 825331 CDM 301 RC facility both 20.47 20.47 Gross Charge Type: NIHD_Hosp_Profee_Price Cort Bind Glob LC 825331 CDM 301 RC facility both 20.47 20.47 Gross Charge Type: NIHD_Hosp_Profee_Price Cortisol - AM LC 825332 CDM 301 RC facility both 2.28 2.28 Gross Charge Type: NIHD_Hosp_Profee_Price Cortisol - AM LC 825332 CDM 301 RC facility both 2.28 2.28 Gross Charge Type: NIHD_Hosp_Profee_Price Cortisol LC 825333 CDM 301 RC facility both 2.28 2.28 Gross Charge Type: NIHD_Hosp_Profee_Price Cortisol LC 825333 CDM 301 RC facility both 2.28 2.28 Gross Charge Type: NIHD_Hosp_Profee_Price "Cortisol, ACTH Stimulation LC" 825334 CDM 301 RC facility both 4.56 4.56 Gross Charge Type: NIHD_Hosp_Profee_Price "Cortisol, ACTH Stimulation LC" 825334 CDM 301 RC facility both 4.56 4.56 Gross Charge Type: NIHD_Hosp_Profee_Price Creatinine Urine 82540 CDM 301 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price Creatinine Urine 82540 CDM 301 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "Valproic Acid (Depakote)(R),S LC" 82542 CDM 301 RC facility both 19.89 19.89 Gross Charge Type: NIHD_Hosp_Profee_Price "Valproic Acid (Depakote)(R),S LC" 82542 CDM 301 RC facility both 19.89 19.89 Gross Charge Type: NIHD_Hosp_Profee_Price Creatine Kinase 82550 CDM 301 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Creatine Kinase 82550 CDM 301 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "Creatine Kinase (CK), MB LC" 82553 CDM 300 RC facility both 22.48 22.48 Gross Charge Type: NIHD_Hosp_Profee_Price "Creatine Kinase (CK), MB LC" 82553 CDM 300 RC facility both 22.48 22.48 Gross Charge Type: NIHD_Hosp_Profee_Price Creatinine 82565 CDM 301 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price Creatinine 82565 CDM 301 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price Ca/Creat Ratio LC 825701_1 CDM 301 RC facility both 3.87 3.87 Gross Charge Type: NIHD_Hosp_Profee_Price Ca/Creat Ratio LC 825701_1 CDM 301 RC facility both 3.87 3.87 Gross Charge Type: NIHD_Hosp_Profee_Price "Creatinine, U LC" 825701_2 CDM 301 RC facility both 8.15 8.15 Gross Charge Type: NIHD_Hosp_Profee_Price "Creatinine, U LC" 825701_2 CDM 301 RC facility both 8.15 8.15 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Creatinine 825702 CDM 301 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Creatinine 825702 CDM 301 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price Citric Acid(Citrate) U 24h LC 825703 CDM 301 RC facility both 4.41 4.41 Gross Charge Type: NIHD_Hosp_Profee_Price Citric Acid(Citrate) U 24h LC 825703 CDM 301 RC facility both 4.41 4.41 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Creatinine 825704 CDM 301 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Creatinine 825704 CDM 301 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price Creatinine Level 24 Hour Urine 825705 CDM 301 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price Creatinine Level 24 Hour Urine 825705 CDM 301 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price Creatinine Clearance 82575 CDM 301 RC facility both 263 263 Gross Charge Type: NIHD_Hosp_Profee_Price Creatinine Clearance 82575 CDM 301 RC facility both 263 263 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 LC 82607 CDM 301 RC facility both 13 13 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 LC 82607 CDM 301 RC facility both 13 13 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 Level 826071 CDM 301 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 Level 826071 CDM 301 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 Level 826072 CDM 301 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 Level 826072 CDM 301 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 Level 826073 CDM 301 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B12 Level 826073 CDM 301 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Cystatin C LC 82610 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price Cystatin C LC 82610 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "DHEA, Serum LC" 82626 CDM 301 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price "DHEA, Serum LC" 82626 CDM 301 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price Dihydrotestosterone LC 82643 CDM 301 RC facility both 23.83 23.83 Gross Charge Type: NIHD_Hosp_Profee_Price Dihydrotestosterone LC 82643 CDM 301 RC facility both 23.83 23.83 Gross Charge Type: NIHD_Hosp_Profee_Price "Lithium (Eskalith(R)), Serum LC" 82651 CDM 301 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price "Lithium (Eskalith(R)), Serum LC" 82651 CDM 301 RC facility both 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price "Erythropoietin (EPO), Serum LC" 82668 CDM 301 RC facility both 7.33 7.33 Gross Charge Type: NIHD_Hosp_Profee_Price "Erythropoietin (EPO), Serum LC" 82668 CDM 301 RC facility both 7.33 7.33 Gross Charge Type: NIHD_Hosp_Profee_Price "Estradiol, Sensitive LC" 82670 CDM 301 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price "Estradiol, Sensitive LC" 82670 CDM 301 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price Estradiol LC 826701 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price Estradiol LC 826701 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Estrone, Serum LC" 82679 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "Estrone, Serum LC" 82679 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "GI Profile, Stool, PCR LC" 82728 CDM 301 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price "GI Profile, Stool, PCR LC" 82728 CDM 301 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price Ferritin 827281 CDM 301 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price Ferritin 827281 CDM 301 RC facility both 140 140 Gross Charge Type: NIHD_Hosp_Profee_Price Ferritin Level 827282 CDM 301 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price Ferritin Level 827282 CDM 301 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price Fetal Fibronectin 82731 CDM 301 RC facility both 667 667 Gross Charge Type: NIHD_Hosp_Profee_Price Fetal Fibronectin 82731 CDM 301 RC facility both 667 667 Gross Charge Type: NIHD_Hosp_Profee_Price Folate LC 82746 CDM 301 RC facility both 16.76 16.76 Gross Charge Type: NIHD_Hosp_Profee_Price Folate LC 82746 CDM 301 RC facility both 16.76 16.76 Gross Charge Type: NIHD_Hosp_Profee_Price Folate Level 827461 CDM 301 RC facility both 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price Folate Level 827461 CDM 301 RC facility both 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price Folate Level 827462 CDM 301 RC facility both 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price Folate Level 827462 CDM 301 RC facility both 69 69 Gross Charge Type: NIHD_Hosp_Profee_Price Folate Level 827463 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Folate Level 827463 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price WOUND VAC CANNISTER/GEL CS/10 8275010 CDM 271 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price WOUND VAC CANNISTER/GEL CS/10 8275010 CDM 271 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827841 CDM 301 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827841 CDM 301 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 8278410 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 8278410 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 8278411 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 8278411 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 8278412 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 8278412 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 8278413 CDM 300 RC facility both 10.61 10.61 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 8278413 CDM 300 RC facility both 10.61 10.61 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278414 CDM 301 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278414 CDM 301 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278415 CDM 301 RC facility both 3.87 3.87 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278415 CDM 301 RC facility both 3.87 3.87 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278416 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278416 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278417 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278417 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278418 CDM 300 RC facility both 10.61 10.61 Gross Charge Type: NIHD_Hosp_Profee_Price IgM LC 8278418 CDM 300 RC facility both 10.61 10.61 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulins A/G/M, Qn, Ser LC" 8278419 CDM 300 RC facility both 7.32 7.32 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulins A/G/M, Qn, Ser LC" 8278419 CDM 300 RC facility both 7.32 7.32 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgG LC 8278420 CDM 301 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgG LC 8278420 CDM 301 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8278421 CDM 301 RC facility both 17.5 17.5 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8278421 CDM 301 RC facility both 17.5 17.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin A, Qn, Serum LC" 8278422 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin A, Qn, Serum LC" 8278422 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 8278423 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 8278423 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin G, Qn, Serum LC" 8278424 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin G, Qn, Serum LC" 8278424 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 8278425 CDM 301 RC facility both 4.86 4.86 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 8278425 CDM 301 RC facility both 4.86 4.86 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin M, Qn, Serum LC" 8278426 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin M, Qn, Serum LC" 8278426 CDM 300 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827844 CDM 301 RC facility both 3.87 3.87 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827844 CDM 301 RC facility both 3.87 3.87 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827845 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827845 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827846 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827846 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827847 CDM 300 RC facility both 10.61 10.61 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 827847 CDM 300 RC facility both 10.61 10.61 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 827848 CDM 301 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 827848 CDM 301 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 827849 CDM 301 RC facility both 3.87 3.87 Gross Charge Type: NIHD_Hosp_Profee_Price IgG LC 827849 CDM 301 RC facility both 3.87 3.87 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin E, Total LC" 827851 CDM 301 RC facility both 4.25 4.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin E, Total LC" 827851 CDM 301 RC facility both 4.25 4.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin E, Ttl LC" 827852 CDM 301 RC facility both 3.86 3.86 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin E, Ttl LC" 827852 CDM 301 RC facility both 3.86 3.86 Gross Charge Type: NIHD_Hosp_Profee_Price "W014-IgE Pigweed, Common LC" 827853 CDM 301 RC facility both 3.29 3.29 Gross Charge Type: NIHD_Hosp_Profee_Price "W014-IgE Pigweed, Common LC" 827853 CDM 301 RC facility both 3.29 3.29 Gross Charge Type: NIHD_Hosp_Profee_Price Allergens w/Total IgE Area 15 LC 827854 CDM 302 RC facility both 3.33 3.33 Gross Charge Type: NIHD_Hosp_Profee_Price Allergens w/Total IgE Area 15 LC 827854 CDM 302 RC facility both 3.33 3.33 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 4 LC" 827871 CDM 301 RC facility both 10.52 10.52 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 4 LC" 827871 CDM 301 RC facility both 10.52 10.52 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 1 LC" 827872 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 1 LC" 827872 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 2 LC" 827873 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 2 LC" 827873 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 3 LC" 827874 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 3 LC" 827874 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 4 LC" 827875 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price "IgG, Subclass 4 LC" 827875 CDM 301 RC facility both 4.51 4.51 Gross Charge Type: NIHD_Hosp_Profee_Price pH Venous 82800 CDM 301 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price pH Venous 82800 CDM 301 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Capillary RT 82801 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Capillary RT 82801 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price 82803 ABG ARTERIAL BLOOD GAS CHARGE 82803 CDM 301 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price 82803 ABG ARTERIAL BLOOD GAS CHARGE 82803 CDM 301 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Blood Alcohol Collection Regular Hours 82804 CDM 300 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Blood Alcohol Collection Regular Hours 82804 CDM 300 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Cord Venous RT 82805 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Cord Venous RT 82805 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Arterial RT 828051 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Arterial RT 828051 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Cord Arterial RT 828052 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Cord Arterial RT 828052 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Venous RT 828053 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Gas Venous RT 828053 CDM 301 RC facility both 924 924 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Blood Alcohol Collection After Hours 82806 CDM facility both 323 323 Gross Charge Type: NIHD_Clinic_Price Bill Only Blood Alcohol Collection After Hours 82806 CDM 300 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Blood Alcohol Collection After Hours 82806 CDM 300 RC facility both 323 323 Gross Charge Type: NIHD_Hosp_Profee_Price "Glucose, Body Fluid LC" 82945 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Glucose, Body Fluid LC" 82945 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose 2 Hour Post Prandial 829471 CDM 301 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose 2 Hour Post Prandial 829471 CDM 301 RC facility both 93 93 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose Fasting 829472 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose Fasting 829472 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose Level 829473 CDM 301 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose Level 829473 CDM 301 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose CSF 82950 CDM 301 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose CSF 82950 CDM 301 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose Tolerance 1 Hr - 50gm 829501 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose Tolerance 1 Hr - 50gm 829501 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose Tolerance OB - 75gm 829502 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose Tolerance OB - 75gm 829502 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT Fasting OB 829511 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT Fasting OB 829511 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price .Glucose Fasting 829512 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price .Glucose Fasting 829512 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR 829521 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR 829521 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR 100gm 829522 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR 100gm 829522 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR 75gm 829523 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR 75gm 829523 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR OB 829524 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR OB 829524 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR OB 100gm 829525 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price .GTT 3 HR OB 100gm 829525 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price RBC LC 82955 CDM 305 RC facility both 3.66 3.66 Gross Charge Type: NIHD_Hosp_Profee_Price RBC LC 82955 CDM 305 RC facility both 3.66 3.66 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose POCT 82962 CDM 300 RC 82962 HCPCS facility both 41 41 Gross Charge Type: NIHD_RHC_Price Glucose POCT 82962 CDM 300 RC 82962 HCPCS facility both 41 41 Gross Charge Type: NIHD_Clinic_Price Glucose POCT 82962 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Glucose POCT 82962 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Gamma Glutamyl Transferase 82977 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Gamma Glutamyl Transferase 82977 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price "FSH, Serum LC" 83001 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "FSH, Serum LC" 83001 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price FSH LC 830012 CDM 300 RC facility both 3.63 3.63 Gross Charge Type: NIHD_Hosp_Profee_Price FSH LC 830012 CDM 300 RC facility both 3.63 3.63 Gross Charge Type: NIHD_Hosp_Profee_Price "Luteinizing Hormone(LH), S LC" 83002 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Luteinizing Hormone(LH), S LC" 83002 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price LH LC 830021 CDM 300 RC facility both 3.63 3.63 Gross Charge Type: NIHD_Hosp_Profee_Price LH LC 830021 CDM 300 RC facility both 3.63 3.63 Gross Charge Type: NIHD_Hosp_Profee_Price "Growth Hormone, Serum LC" 83003 CDM 301 RC facility both 7.94 7.94 Gross Charge Type: NIHD_Hosp_Profee_Price "Growth Hormone, Serum LC" 83003 CDM 301 RC facility both 7.94 7.94 Gross Charge Type: NIHD_Hosp_Profee_Price Haptoglobin LC 83010 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price Haptoglobin LC 83010 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price H pylori Breath Test LC 83013 CDM 301 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price H pylori Breath Test LC 83013 CDM 301 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price Newborn Metabolic Screen 83021 CDM 301 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price Newborn Metabolic Screen 83021 CDM 301 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price Hemoglobin A1c w/eAG 830361 CDM 301 RC facility both 213 213 Gross Charge Type: NIHD_Hosp_Profee_Price Hemoglobin A1c w/eAG 830361 CDM 301 RC facility both 213 213 Gross Charge Type: NIHD_Hosp_Profee_Price Hgb A1c 830362 CDM 301 RC facility both 213 213 Gross Charge Type: NIHD_Hosp_Profee_Price Hgb A1c 830362 CDM 301 RC facility both 213 213 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Nursery 8307334 CDM 170 RC facility both 1349 1349 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Nursery 8307334 CDM 170 RC facility both 1349 1349 Gross Charge Type: NIHD_Hosp_Profee_Price Homocyst(e)ine LC 83090 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price Homocyst(e)ine LC 83090 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price VAGINAL DELIVERY LEVEL 1 CHARGE 8314318 CDM 720 RC facility both 3867 3867 Gross Charge Type: NIHD_Hosp_Profee_Price VAGINAL DELIVERY LEVEL 1 CHARGE 8314318 CDM 720 RC facility both 3867 3867 Gross Charge Type: NIHD_Hosp_Profee_Price Pre-Employment Physical 8335693 CDM 521 RC facility both 198 198 Gross Charge Type: NIHD_RHC_Price Pre-Employment Physical 8335693 CDM 521 RC facility both 198 198 Gross Charge Type: NIHD_Clinic_Price 17-OH Progesterone LCMS LC 834982 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price 17-OH Progesterone LCMS LC 834982 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price 83516-Antineutrophil Cytoplasmic Antibody (ANCA) Profile LC 83516_1 CDM 301 RC 83516 HCPCS facility both 6.72 6.72 Gross Charge Type: NIHD_Hosp_Profee_Price 83516-Antineutrophil Cytoplasmic Antibody (ANCA) Profile LC 83516_1 CDM 301 RC 83516 HCPCS facility both 6.72 6.72 Gross Charge Type: NIHD_Hosp_Profee_Price Scleroderma Comprehensive Plus Profile (RDL) LC 83516_2 CDM 301 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price Scleroderma Comprehensive Plus Profile (RDL) LC 83516_2 CDM 301 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price .Glia(IgG)+tTG(IgG) LC 835161 CDM 301 RC facility both 8.96 8.96 Gross Charge Type: NIHD_Hosp_Profee_Price .Glia(IgG)+tTG(IgG) LC 835161 CDM 301 RC facility both 8.96 8.96 Gross Charge Type: NIHD_Hosp_Profee_Price "Gliadin IgG/IgA Ab Prof, EIA LC" 8351610 CDM 301 RC facility both 7.34 7.34 Gross Charge Type: NIHD_Hosp_Profee_Price "Gliadin IgG/IgA Ab Prof, EIA LC" 8351610 CDM 301 RC facility both 7.34 7.34 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgA LC" 8351611 CDM 301 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgA LC" 8351611 CDM 301 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price Mitochondrial (M2) Antibody LC 8351612 CDM 301 RC facility both 5.95 5.95 Gross Charge Type: NIHD_Hosp_Profee_Price Mitochondrial (M2) Antibody LC 8351612 CDM 301 RC facility both 5.95 5.95 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgG LC" 8351613 CDM 301 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgG LC" 8351613 CDM 301 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price tTG IgA/G LC 8351614 CDM 301 RC facility both 10.58 10.58 Gross Charge Type: NIHD_Hosp_Profee_Price tTG IgA/G LC 8351614 CDM 301 RC facility both 10.58 10.58 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgA LC" 8351615 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgA LC" 8351615 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8351616 CDM 301 RC facility both 5.29 5.29 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8351616 CDM 301 RC facility both 5.29 5.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgG LC" 8351618 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price "Deamidated Gliadin Abs, IgG LC" 8351618 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 8351619 CDM 300 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 8351619 CDM 300 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price AMCA LC 835162 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price AMCA LC 835162 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgG LC 8351620 CDM 301 RC facility both 5.29 5.29 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgG LC 8351620 CDM 301 RC facility both 5.29 5.29 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 8351621 CDM 301 RC facility both 17.5 17.5 Gross Charge Type: NIHD_Hosp_Profee_Price IgA LC 8351621 CDM 301 RC facility both 17.5 17.5 Gross Charge Type: NIHD_Hosp_Profee_Price RA Latex Turbid. LC 8351622 CDM 301 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price RA Latex Turbid. LC 8351622 CDM 301 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price gASCA LC 8351623 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price gASCA LC 8351623 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8351624 CDM 301 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8351624 CDM 301 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8351625 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8351625 CDM 301 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgG LC 8351626 CDM 301 RC facility both 4.52 4.52 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgG LC 8351626 CDM 301 RC facility both 4.52 4.52 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8351627_1 CDM 301 RC facility both 4.87 4.87 Gross Charge Type: NIHD_Hosp_Profee_Price t-Transglutaminase (tTG) IgA LC 8351627_1 CDM 301 RC facility both 4.87 4.87 Gross Charge Type: NIHD_Hosp_Profee_Price Antineutrophil Cytoplasmic Antibody (ANCA) Profile LC 8351627_2 CDM 301 RC facility both 6.72 6.72 Gross Charge Type: NIHD_Hosp_Profee_Price Antineutrophil Cytoplasmic Antibody (ANCA) Profile LC 8351627_2 CDM 301 RC facility both 6.72 6.72 Gross Charge Type: NIHD_Hosp_Profee_Price Actin (Smooth Muscle) Antibody LC 835163 CDM 301 RC facility both 5.29 5.29 Gross Charge Type: NIHD_Hosp_Profee_Price Actin (Smooth Muscle) Antibody LC 835163 CDM 301 RC facility both 5.29 5.29 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 835164 CDM 302 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 835164 CDM 302 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-intermyofibrillar LC 835165 CDM 301 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-intermyofibrillar LC 835165 CDM 301 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Antiglomerular BM Ab LC 835166 CDM 301 RC facility both 7.33 7.33 Gross Charge Type: NIHD_Hosp_Profee_Price Antiglomerular BM Ab LC 835166 CDM 301 RC facility both 7.33 7.33 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-sarcolemma LC 835167 CDM 301 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-sarcolemma LC 835167 CDM 301 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Atyp pANCA LC 835169 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price Atyp pANCA LC 835169 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price "Hymenoptera Venom Allergy (HVA) With Components Profile, II" 83520_1 CDM 301 RC facility both 6 6 Gross Charge Type: NIHD_Hosp_Profee_Price "Hymenoptera Venom Allergy (HVA) With Components Profile, II" 83520_1 CDM 301 RC facility both 6 6 Gross Charge Type: NIHD_Hosp_Profee_Price RheumAssure® LC 504509 83520_2 CDM 301 RC facility both 14.37 14.37 Gross Charge Type: NIHD_Hosp_Profee_Price RheumAssure® LC 504509 83520_2 CDM 301 RC facility both 14.37 14.37 Gross Charge Type: NIHD_Hosp_Profee_Price Atypical pANCA LC 835201 CDM 301 RC facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price Atypical pANCA LC 835201 CDM 301 RC facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price Tryptase LC 835202 CDM 300 RC facility both 35.71 35.71 Gross Charge Type: NIHD_Hosp_Profee_Price Tryptase LC 835202 CDM 300 RC facility both 35.71 35.71 Gross Charge Type: NIHD_Hosp_Profee_Price Cytoplasmic (C-ANCA) LC 835203 CDM 301 RC facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price Cytoplasmic (C-ANCA) LC 835203 CDM 301 RC facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price "Thyrotropin Receptor Ab, Serum LC" 835204 CDM 300 RC facility both 13.85 13.85 Gross Charge Type: NIHD_Hosp_Profee_Price "Thyrotropin Receptor Ab, Serum LC" 835204 CDM 300 RC facility both 13.85 13.85 Gross Charge Type: NIHD_Hosp_Profee_Price IGF-BP3 LC 835205 CDM 300 RC facility both 23.42 23.42 Gross Charge Type: NIHD_Hosp_Profee_Price IGF-BP3 LC 835205 CDM 300 RC facility both 23.42 23.42 Gross Charge Type: NIHD_Hosp_Profee_Price "Pancreatic Elastase, Fecal LC" 835206 CDM 300 RC facility both 165 165 Gross Charge Type: NIHD_Hosp_Profee_Price "Pancreatic Elastase, Fecal LC" 835206 CDM 300 RC facility both 165 165 Gross Charge Type: NIHD_Hosp_Profee_Price NMO IgG Autoantibodies LC 835207 CDM 300 RC facility both 300 300 Gross Charge Type: NIHD_Hosp_Profee_Price NMO IgG Autoantibodies LC 835207 CDM 300 RC facility both 300 300 Gross Charge Type: NIHD_Hosp_Profee_Price Perinuclear (P-ANCA) LC 835208 CDM 301 RC facility both 6.71 6.71 Gross Charge Type: NIHD_Hosp_Profee_Price Perinuclear (P-ANCA) LC 835208 CDM 301 RC facility both 6.71 6.71 Gross Charge Type: NIHD_Hosp_Profee_Price Inhibin B LC 835209 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Inhibin B LC 835209 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Progesterone LC 83521 CDM 301 RC facility both 3.37 3.37 Gross Charge Type: NIHD_Hosp_Profee_Price Progesterone LC 83521 CDM 301 RC facility both 3.37 3.37 Gross Charge Type: NIHD_Hosp_Profee_Price C-Peptide LC 835251 CDM 301 RC facility both 3.51 3.51 Gross Charge Type: NIHD_Hosp_Profee_Price C-Peptide LC 835251 CDM 301 RC facility both 3.51 3.51 Gross Charge Type: NIHD_Hosp_Profee_Price Insulin LC 835252 CDM 301 RC facility both 3.37 3.37 Gross Charge Type: NIHD_Hosp_Profee_Price Insulin LC 835252 CDM 301 RC facility both 3.37 3.37 Gross Charge Type: NIHD_Hosp_Profee_Price Aldolase LC 83540 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price Aldolase LC 83540 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 835401 CDM 301 RC facility both 120 120 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 835401 CDM 301 RC facility both 120 120 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 835402 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 835402 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 8354023 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 8354023 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 835403 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 835403 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 835404 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Iron Level 835404 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Total Iron Binding Capacity 83550 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Total Iron Binding Capacity 83550 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Total Iron Binding Capacity 835501 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Total Iron Binding Capacity 835501 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Unsaturated Iron Binding Capacity 8355012 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Unsaturated Iron Binding Capacity 8355012 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Total Iron Binding Capacity 835502 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Total Iron Binding Capacity 835502 CDM 301 RC facility both 100 100 Gross Charge Type: NIHD_Hosp_Profee_Price Total Iron Binding Capacity 835503 CDM 301 RC facility both 86 86 Gross Charge Type: NIHD_Hosp_Profee_Price Total Iron Binding Capacity 835503 CDM 301 RC facility both 86 86 Gross Charge Type: NIHD_Hosp_Profee_Price LA Ven 83605 CDM 301 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price LA Ven 83605 CDM 301 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price "LD, Body Fluid LC" 8361511 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price "LD, Body Fluid LC" 8361511 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price Lactate Dehydrogenase LC 8361512 CDM 301 RC facility both 6 6 Gross Charge Type: NIHD_Hosp_Profee_Price Lactate Dehydrogenase LC 8361512 CDM 301 RC facility both 6 6 Gross Charge Type: NIHD_Hosp_Profee_Price Lactate Dehydrogenase 836152 CDM 301 RC facility both 191 191 Gross Charge Type: NIHD_Hosp_Profee_Price Lactate Dehydrogenase 836152 CDM 301 RC facility both 191 191 Gross Charge Type: NIHD_Hosp_Profee_Price "Lactoferrin, Fecal, Quant. LC" 83631 CDM 301 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price "Lactoferrin, Fecal, Quant. LC" 83631 CDM 301 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Capillary Lead POCT 836551 CDM 521 RC 83655 HCPCS facility both 83 83 Gross Charge Type: NIHD_RHC_Price Capillary Lead POCT 836551 CDM 521 RC 83655 HCPCS facility both 83 83 Gross Charge Type: NIHD_Clinic_Price Capillary Lead POCT 836551 CDM 301 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price Capillary Lead POCT 836551 CDM 301 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price Lead LC 836552 CDM 301 RC facility both 13.05 13.05 Gross Charge Type: NIHD_Hosp_Profee_Price Lead LC 836552 CDM 301 RC facility both 13.05 13.05 Gross Charge Type: NIHD_Hosp_Profee_Price "Lead, Blood (Adult) LC" 836553 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Lead, Blood (Adult) LC" 836553 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Lead, Blood (Pediatric) LC" 836554 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Lead, Blood (Pediatric) LC" 836554 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Lipase Level 83690 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price Lipase Level 83690 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price Lp-PLA2 Activity LC 83698 CDM 301 RC facility both 20 20 Gross Charge Type: NIHD_Hosp_Profee_Price Lp-PLA2 Activity LC 83698 CDM 301 RC facility both 20 20 Gross Charge Type: NIHD_Hosp_Profee_Price NMR LipoProfile LC 83704_1 CDM 301 RC facility both 16.31 16.31 Gross Charge Type: NIHD_Hosp_Profee_Price NMR LipoProfile LC 83704_1 CDM 301 RC facility both 16.31 16.31 Gross Charge Type: NIHD_Hosp_Profee_Price NMR LipoProfile+IR+Graph LC 83704_2 CDM 301 RC facility both 32.61 32.61 Gross Charge Type: NIHD_Hosp_Profee_Price NMR LipoProfile+IR+Graph LC 83704_2 CDM 301 RC facility both 32.61 32.61 Gross Charge Type: NIHD_Hosp_Profee_Price .Lipoprotein Analysis by NMR 123482 LC 837041 CDM 301 RC facility both 32.61 32.61 Gross Charge Type: NIHD_Hosp_Profee_Price .Lipoprotein Analysis by NMR 123482 LC 837041 CDM 301 RC facility both 32.61 32.61 Gross Charge Type: NIHD_Hosp_Profee_Price HDL Cholesterol 83718 CDM 301 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price HDL Cholesterol 83718 CDM 301 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price .LDL Cholesterol (Direct) 123506 LC 837211 CDM 300 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price .LDL Cholesterol (Direct) 123506 LC 837211 CDM 300 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price LDL Direct 837212 CDM 301 RC facility both 182 182 Gross Charge Type: NIHD_Hosp_Profee_Price LDL Direct 837212 CDM 301 RC facility both 182 182 Gross Charge Type: NIHD_Hosp_Profee_Price Citric Acid (Citrate) LC 83735 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price Citric Acid (Citrate) LC 83735 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price Magnesium Level 837351 CDM 301 RC facility both 251 251 Gross Charge Type: NIHD_Hosp_Profee_Price Magnesium Level 837351 CDM 301 RC facility both 251 251 Gross Charge Type: NIHD_Hosp_Profee_Price "Magnesium, RBC LC" 837352 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Magnesium, RBC LC" 837352 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price Iron LC 837892 CDM 300 RC facility both 38 38 Gross Charge Type: NIHD_Hosp_Profee_Price Iron LC 837892 CDM 300 RC facility both 38 38 Gross Charge Type: NIHD_Hosp_Profee_Price Mercury LC 838251 CDM 301 RC facility both 13.03 13.03 Gross Charge Type: NIHD_Hosp_Profee_Price Mercury LC 838251 CDM 301 RC facility both 13.03 13.03 Gross Charge Type: NIHD_Hosp_Profee_Price "Mercury, Blood LC" 838252 CDM 301 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price "Mercury, Blood LC" 838252 CDM 301 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price "Metanephrines, Frac., Pl. Free LC" 83835 CDM 301 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price "Metanephrines, Frac., Pl. Free LC" 83835 CDM 301 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price "Metanephrines, Frac, Qn, 24-Hr LC" 838351 CDM 301 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price "Metanephrines, Frac, Qn, 24-Hr LC" 838351 CDM 301 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price Myoglobin 83874 CDM 301 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price Myoglobin 83874 CDM 301 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price Myeloperoxidase (MPO) LC 83876 CDM 301 RC facility both 38 38 Gross Charge Type: NIHD_Hosp_Profee_Price Myeloperoxidase (MPO) LC 83876 CDM 301 RC facility both 38 38 Gross Charge Type: NIHD_Hosp_Profee_Price B-Type Natriuretic Peptide 838801 CDM 301 RC facility both 366 366 Gross Charge Type: NIHD_Hosp_Profee_Price B-Type Natriuretic Peptide 838801 CDM 301 RC facility both 366 366 Gross Charge Type: NIHD_Hosp_Profee_Price NT-proBNP LC 838802 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price NT-proBNP LC 838802 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-1-Globulin: LC 838831 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-1-Globulin: LC 838831 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price "Free K+L Lt Chains,Qn,24 hr U LC" 838832 CDM 301 RC facility both 53.25 53.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Free K+L Lt Chains,Qn,24 hr U LC" 838832 CDM 301 RC facility both 53.25 53.25 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-2-Globulin: LC 838833 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-2-Globulin: LC 838833 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price "Free K+L Lt Chains,Qn,S LC" 838834 CDM 301 RC facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price "Free K+L Lt Chains,Qn,S LC" 838834 CDM 301 RC facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price "Methylmalonic Acid, Serum LC" 83921 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "Methylmalonic Acid, Serum LC" 83921 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price PTT-LA LC 8392902 CDM 301 RC facility both 8.75 8.75 Gross Charge Type: NIHD_Hosp_Profee_Price PTT-LA LC 8392902 CDM 301 RC facility both 8.75 8.75 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT LC 8392903 CDM 301 RC facility both 8.75 8.75 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT LC 8392903 CDM 301 RC facility both 8.75 8.75 Gross Charge Type: NIHD_Hosp_Profee_Price Osmolality Serum 839301 CDM 301 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price Osmolality Serum 839301 CDM 301 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price "Phenytoin (Dilantin), Serum LC" 839302 CDM 301 RC facility both 292 292 Gross Charge Type: NIHD_Hosp_Profee_Price "Phenytoin (Dilantin), Serum LC" 839302 CDM 301 RC facility both 292 292 Gross Charge Type: NIHD_Hosp_Profee_Price Uric Acid U 24h LC 83935 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Uric Acid U 24h LC 83935 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Osmolality Urine 839351 CDM 301 RC facility both 332 332 Gross Charge Type: NIHD_Hosp_Profee_Price Osmolality Urine 839351 CDM 301 RC facility both 332 332 Gross Charge Type: NIHD_Hosp_Profee_Price "Osmolality, Urine LC" 839352 CDM 301 RC facility both 5.09 5.09 Gross Charge Type: NIHD_Hosp_Profee_Price "Osmolality, Urine LC" 839352 CDM 301 RC facility both 5.09 5.09 Gross Charge Type: NIHD_Hosp_Profee_Price "Oxalate, Quant, 24-Hour Urine LC" 839451 CDM 301 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "Oxalate, Quant, 24-Hour Urine LC" 839451 CDM 301 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "Sodium, Ur LC" 839452 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price "Sodium, Ur LC" 839452 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price PTH Intact 839701 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price PTH Intact 839701 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price "PTH, Intact LC" 839702 CDM 301 RC facility both 15.5 15.5 Gross Charge Type: NIHD_Hosp_Profee_Price "PTH, Intact LC" 839702 CDM 301 RC facility both 15.5 15.5 Gross Charge Type: NIHD_Hosp_Profee_Price "PTH, Intact LC" 839703 CDM 301 RC facility both 4.03 4.03 Gross Charge Type: NIHD_Hosp_Profee_Price "PTH, Intact LC" 839703 CDM 301 RC facility both 4.03 4.03 Gross Charge Type: NIHD_Hosp_Profee_Price Lacrimal pH POCT 83986_300 CDM 300 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Lacrimal pH POCT 83986_300 CDM 300 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price pH Body Fluid 83986_301 CDM 301 RC facility both 7 7 Gross Charge Type: NIHD_Hosp_Profee_Price pH Body Fluid 83986_301 CDM 301 RC facility both 7 7 Gross Charge Type: NIHD_Hosp_Profee_Price .Phencyclidine-Confirm LC 83992 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Phencyclidine-Confirm LC 83992 CDM 301 RC facility both 119.5 119.5 Gross Charge Type: NIHD_Hosp_Profee_Price ".Phencyclidine (GC/MS), Urine LC" 839921 CDM 301 RC facility both 12.74 12.74 Gross Charge Type: NIHD_Hosp_Profee_Price ".Phencyclidine (GC/MS), Urine LC" 839921 CDM 301 RC facility both 12.74 12.74 Gross Charge Type: NIHD_Hosp_Profee_Price "Calprotectin, Fecal LC" 83993 CDM 301 RC facility both 91.25 91.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Calprotectin, Fecal LC" 83993 CDM 301 RC facility both 91.25 91.25 Gross Charge Type: NIHD_Hosp_Profee_Price Alkaline Phosphatase 840751 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Alkaline Phosphatase 840751 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Alkaline Phosphatase LC 840752 CDM 300 RC facility both 2.5 2.5 Gross Charge Type: NIHD_Hosp_Profee_Price Alkaline Phosphatase LC 840752 CDM 300 RC facility both 2.5 2.5 Gross Charge Type: NIHD_Hosp_Profee_Price Liver Fraction: LC 84080 CDM 300 RC facility both 2.5 2.5 Gross Charge Type: NIHD_Hosp_Profee_Price Liver Fraction: LC 84080 CDM 300 RC facility both 2.5 2.5 Gross Charge Type: NIHD_Hosp_Profee_Price Phosphorus Level 84100 CDM 301 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price Phosphorus Level 84100 CDM 301 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price "Phosphorus, Random Urine LC" 841051 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price "Phosphorus, Random Urine LC" 841051 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price "Phosphorus, 24 hr Urine LC" 841052 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price "Phosphorus, 24 hr Urine LC" 841052 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price "Potassium, Ur LC" 841053 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price "Potassium, Ur LC" 841053 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Amnisure ROM 84112 CDM 301 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price Amnisure ROM 84112 CDM 301 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price Potassium Level 84132 CDM 301 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price Potassium Level 84132 CDM 301 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price "Chloride, Ur LC" 84133 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price "Chloride, Ur LC" 84133 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Potassium Level 24 Hour Urine 841331 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Potassium Level 24 Hour Urine 841331 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Potassium Level Urine 841332 CDM 301 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Potassium Level Urine 841332 CDM 301 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Prealbumin LC 84134 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price Prealbumin LC 84134 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price Procalcitonin 84145 CDM 301 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price Procalcitonin 84145 CDM 301 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price Prolactin LC 84146 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Prolactin LC 84146 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price PSA Total with reflex to Free PSA 84153 CDM 300 RC 84153 HCPCS facility both 4.88 4.88 Gross Charge Type: NIHD_Hosp_Tech_Price PSA Total with reflex to Free PSA 84153 CDM 300 RC 84153 HCPCS facility both 158 158 Gross Charge Type: NIHD_Hosp_Profee_Price Prostate Specific Ag LC 84153_300 CDM 300 RC 84153 HCPCS facility both 4.88 4.88 Gross Charge Type: NIHD_Hosp_Tech_Price PSA Total with reflex to Free PSA 84153_301 CDM 301 RC facility both 158 158 Gross Charge Type: NIHD_Hosp_Profee_Price PSA Diagnostic 8415311 CDM 301 RC facility both 257 257 Gross Charge Type: NIHD_Hosp_Profee_Price PSA Diagnostic 8415311 CDM 301 RC facility both 257 257 Gross Charge Type: NIHD_Hosp_Profee_Price Prostate-Specific Ag LC 8415312 CDM 301 RC facility both 55.59 55.59 Gross Charge Type: NIHD_Hosp_Profee_Price Prostate-Specific Ag LC 8415312 CDM 301 RC facility both 55.59 55.59 Gross Charge Type: NIHD_Hosp_Profee_Price PSA Total (Reflex To Free) LC 8415321 CDM 301 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price PSA Total (Reflex To Free) LC 8415321 CDM 301 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price "PSA, Ultrasensitive W/O Serial LC" 8415322 CDM 301 RC facility both 22.48 22.48 Gross Charge Type: NIHD_Hosp_Profee_Price "PSA, Ultrasensitive W/O Serial LC" 8415322 CDM 301 RC facility both 22.48 22.48 Gross Charge Type: NIHD_Hosp_Profee_Price PSA % Free LC 84154_300 CDM 300 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price PSA % Free LC 84154_300 CDM 300 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price Prostate Specific Antigen Free 84154_301 CDM 301 RC 84154 HCPCS facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price Prostate Specific Antigen Free 84154_301 CDM 301 RC 84154 HCPCS facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price "Prostate Specific Antigen, Free" 841541 CDM 301 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price "Prostate Specific Antigen, Free" 841541 CDM 301 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price Prostate Specific Antigen Free 841542 CDM 301 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price Prostate Specific Antigen Free 841542 CDM 301 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-1-Globulin LC 84155 CDM 301 RC facility both 2.64 2.64 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-1-Globulin LC 84155 CDM 301 RC facility both 2.64 2.64 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-1-Globulin: LC 841551 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-1-Globulin: LC 841551 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price Protein Total 841552 CDM 301 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Protein Total 841552 CDM 301 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein, Ttl S LC" 841553 CDM 301 RC facility both 5.64 5.64 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein, Ttl S LC" 841553 CDM 301 RC facility both 5.64 5.64 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein, Ttl S LC" 841554 CDM 301 RC facility both 2.96 2.96 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein, Ttl S LC" 841554 CDM 301 RC facility both 2.96 2.96 Gross Charge Type: NIHD_Hosp_Profee_Price "Albumin, Ur LC" 841561 CDM 301 RC facility both 5.4 5.4 Gross Charge Type: NIHD_Hosp_Profee_Price "Albumin, Ur LC" 841561 CDM 301 RC facility both 5.4 5.4 Gross Charge Type: NIHD_Hosp_Profee_Price Protein Level 24 Hour Urine 841562 CDM 301 RC facility both 182 182 Gross Charge Type: NIHD_Hosp_Profee_Price Protein Level 24 Hour Urine 841562 CDM 301 RC facility both 182 182 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein Total, Qn, 24hr Ur LC" 841563 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein Total, Qn, 24hr Ur LC" 841563 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price Protein Urine 841564 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price Protein Urine 841564 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Protein Level 841565 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Protein Level 841565 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Protein POC (RE) 841566 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Protein POC (RE) 841566 CDM 301 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price Total Volume (mL) LC 841567 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price Total Volume (mL) LC 841567 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein, Body Fluid LC" 84157 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein, Body Fluid LC" 84157 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price Protein Cerebrospinal Fluid 841571 CDM 301 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price Protein Cerebrospinal Fluid 841571 CDM 301 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-2-Globulin LC 84165 CDM 301 RC facility both 2.65 2.65 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-2-Globulin LC 84165 CDM 301 RC facility both 2.65 2.65 Gross Charge Type: NIHD_Hosp_Profee_Price Albumin: LC 841653_1 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price Albumin: LC 841653_1 CDM 301 RC facility both 2.1 2.1 Gross Charge Type: NIHD_Hosp_Profee_Price Albumin Lvl LC 841653_2 CDM 301 RC facility both 2.96 2.96 Gross Charge Type: NIHD_Hosp_Profee_Price Albumin Lvl LC 841653_2 CDM 301 RC facility both 2.96 2.96 Gross Charge Type: NIHD_Hosp_Profee_Price Beta Globulin: LC 841654 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price Beta Globulin: LC 841654 CDM 301 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price "Alpha-2-Globulin, U LC" 84166 CDM 301 RC facility both 5.39 5.39 Gross Charge Type: NIHD_Hosp_Profee_Price "Alpha-2-Globulin, U LC" 84166 CDM 301 RC facility both 5.39 5.39 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-2-Glob U LC 841661 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price Alpha-2-Glob U LC 841661 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price IUPC APPLICATION CHARGE 8418583 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price IUPC APPLICATION CHARGE 8418583 CDM 272 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price "Zinc, Plasma or Serum LC" 84207 CDM 301 RC facility both 4.28 4.28 Gross Charge Type: NIHD_Hosp_Profee_Price "Zinc, Plasma or Serum LC" 84207 CDM 301 RC facility both 4.28 4.28 Gross Charge Type: NIHD_Hosp_Profee_Price Aldos/Renin Ratio LC 842441 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price Aldos/Renin Ratio LC 842441 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Renin Activity, Plasma LC" 842442 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Renin Activity, Plasma LC" 842442 CDM 301 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin B2, Whole Blood LC" 84252 CDM 301 RC facility both 7.75 7.75 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin B2, Whole Blood LC" 84252 CDM 301 RC facility both 7.75 7.75 Gross Charge Type: NIHD_Hosp_Profee_Price "Selenium, Serum/Plasma LC" 84255 CDM 300 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price "Selenium, Serum/Plasma LC" 84255 CDM 300 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price "Selenium, Blood LC" 842551 CDM 301 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price "Selenium, Blood LC" 842551 CDM 301 RC facility both 28.51 28.51 Gross Charge Type: NIHD_Hosp_Profee_Price "Serotonin, Serum LC" 84260 CDM 301 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price "Serotonin, Serum LC" 84260 CDM 301 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price Repair Eyelid 8426340 CDM 360 RC facility both 6766 6766 Gross Charge Type: NIHD_Hosp_Profee_Price Repair Eyelid 8426340 CDM 360 RC facility both 6766 6766 Gross Charge Type: NIHD_Hosp_Profee_Price "Sex Horm Binding Glob, Serum LC" 84270 CDM 301 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price "Sex Horm Binding Glob, Serum LC" 84270 CDM 301 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Level Urine 84294 CDM 301 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Level Urine 84294 CDM 301 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Level 24 Hour Urine 84295 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Level 24 Hour Urine 84295 CDM 301 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Potassium U24 LC 843001 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Potassium U24 LC 843001 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Level 843002 CDM 301 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price Sodium Level 843002 CDM 301 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price IGF-1 LC 84305 CDM 301 RC facility both 6.11 6.11 Gross Charge Type: NIHD_Hosp_Profee_Price IGF-1 LC 84305 CDM 301 RC facility both 6.11 6.11 Gross Charge Type: NIHD_Hosp_Profee_Price Specific Gravity Urine 84315 CDM 300 RC facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price Specific Gravity Urine 84315 CDM 300 RC facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price Uric Acid LC 84392 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price Uric Acid LC 84392 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone, Free, Direct LC" 844021 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone, Free, Direct LC" 844021 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Free Testosterone(Direct) LC 844022 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Free Testosterone(Direct) LC 844022 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Testosterone LC 844032 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Testosterone LC 844032 CDM 301 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone, Serum LC" 844033 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone, Serum LC" 844033 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price 7 X 7 FOAM SACRUM DRESSING 8440682 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 7 X 7 FOAM SACRUM DRESSING 8440682 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone,Free+Weakly Bound LC" 84410 CDM 301 RC facility both 6.52 6.52 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone,Free+Weakly Bound LC" 84410 CDM 301 RC facility both 6.52 6.52 Gross Charge Type: NIHD_Hosp_Profee_Price Bioavailable Testost. w/o SHBG LC 844101 CDM 301 RC facility both 45.61 45.61 Gross Charge Type: NIHD_Hosp_Profee_Price Bioavailable Testost. w/o SHBG LC 844101 CDM 301 RC facility both 45.61 45.61 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone,F/WklyBd+T LC/MS LC" 844102 CDM 301 RC facility both 38.42 38.42 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone,F/WklyBd+T LC/MS LC" 844102 CDM 301 RC facility both 38.42 38.42 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin B1 (Thiamine), Blood LC" 84425 CDM 301 RC facility both 12.14 12.14 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin B1 (Thiamine), Blood LC" 84425 CDM 301 RC facility both 12.14 12.14 Gross Charge Type: NIHD_Hosp_Profee_Price .Thyroglobulin by IMA LC 844321 CDM 301 RC facility both 2.5 2.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Thyroglobulin by IMA LC 844321 CDM 301 RC facility both 2.5 2.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Thyroglobulin by RIA LC 844322 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price .Thyroglobulin by RIA LC 844322 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price .Thyroglobulin by LCMS LC 844323 CDM 301 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price .Thyroglobulin by LCMS LC 844323 CDM 301 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroglobulin (ICMA) LC 844324 CDM 301 RC facility both 23.2 23.2 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroglobulin (ICMA) LC 844324 CDM 301 RC facility both 23.2 23.2 Gross Charge Type: NIHD_Hosp_Profee_Price Total T4 Level 84436 CDM 301 RC facility both 153 153 Gross Charge Type: NIHD_Hosp_Profee_Price Total T4 Level 84436 CDM 301 RC facility both 153 153 Gross Charge Type: NIHD_Hosp_Profee_Price "Thyroxine (T4), Free, Direct LC" 84439 CDM 301 RC facility both 2.2 2.2 Gross Charge Type: NIHD_Hosp_Profee_Price "Thyroxine (T4), Free, Direct LC" 84439 CDM 301 RC facility both 2.2 2.2 Gross Charge Type: NIHD_Hosp_Profee_Price .T4F LC 844391 CDM 301 RC facility both 63.98 63.98 Gross Charge Type: NIHD_Hosp_Profee_Price .T4F LC 844391 CDM 301 RC facility both 63.98 63.98 Gross Charge Type: NIHD_Hosp_Profee_Price Free T4 Level 844392 CDM 301 RC facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price Free T4 Level 844392 CDM 301 RC facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price ".Thyroxine (T4) Free, Direct, S LC" 844393 CDM 301 RC facility both 63.98 63.98 Gross Charge Type: NIHD_Hosp_Profee_Price ".Thyroxine (T4) Free, Direct, S LC" 844393 CDM 301 RC facility both 63.98 63.98 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroxine (T4) Free 844394 CDM 301 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroxine (T4) Free 844394 CDM 301 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "T4, Free(Direct) LC" 844395 CDM 300 RC facility both 5.91 5.91 Gross Charge Type: NIHD_Hosp_Profee_Price "T4, Free(Direct) LC" 844395 CDM 300 RC facility both 5.91 5.91 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Cascade Profile LC 84443 CDM 301 RC facility both 3.71 3.71 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Cascade Profile LC 84443 CDM 301 RC facility both 3.71 3.71 Gross Charge Type: NIHD_Hosp_Profee_Price TSH w/ Rflx to Free T4 844431 CDM 301 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price TSH w/ Rflx to Free T4 844431 CDM 301 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price TSH w/ Rfx to Free T4 LC 844432 CDM 301 RC facility both 6.76 6.76 Gross Charge Type: NIHD_Hosp_Profee_Price TSH w/ Rfx to Free T4 LC 844432 CDM 301 RC facility both 6.76 6.76 Gross Charge Type: NIHD_Hosp_Profee_Price TSH LC 844433 CDM 300 RC facility both 5.91 5.91 Gross Charge Type: NIHD_Hosp_Profee_Price TSH LC 844433 CDM 300 RC facility both 5.91 5.91 Gross Charge Type: NIHD_Hosp_Profee_Price TSH LC 8444331 CDM 301 RC facility both 6.76 6.76 Gross Charge Type: NIHD_Hosp_Profee_Price TSH LC 8444331 CDM 301 RC facility both 6.76 6.76 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Stimulating Hormone 8444332 CDM 301 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Stimulating Hormone 8444332 CDM 301 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Stimulating Hormone 844434 CDM 301 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Stimulating Hormone 844434 CDM 301 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Stim Immunoglobulin LC 84445 CDM 301 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Stim Immunoglobulin LC 84445 CDM 301 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin E LC 84446_1 CDM 300 RC facility both 8.65 8.65 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin E LC 84446_1 CDM 300 RC facility both 8.65 8.65 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin E(Alpha Tocopherol) LC 84446_2 CDM 300 RC facility both 9.11 9.11 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin E(Alpha Tocopherol) LC 84446_2 CDM 300 RC facility both 9.11 9.11 Gross Charge Type: NIHD_Hosp_Profee_Price Cort % Free LC 84449 CDM 301 RC facility both 20.46 20.46 Gross Charge Type: NIHD_Hosp_Profee_Price Cort % Free LC 84449 CDM 301 RC facility both 20.46 20.46 Gross Charge Type: NIHD_Hosp_Profee_Price Aspartate Aminotransferase 84450 CDM 301 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price Aspartate Aminotransferase 84450 CDM 301 RC facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price Alanine Aminotransferase 84460 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price Alanine Aminotransferase 84460 CDM 301 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin C LC 8447599 CDM 301 RC facility both 11.24 11.24 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin C LC 8447599 CDM 301 RC facility both 11.24 11.24 Gross Charge Type: NIHD_Hosp_Profee_Price "Aldosterone LCMS, Serum LC" 8447626 CDM 301 RC facility both 4.23 4.23 Gross Charge Type: NIHD_Hosp_Profee_Price "Aldosterone LCMS, Serum LC" 8447626 CDM 301 RC facility both 4.23 4.23 Gross Charge Type: NIHD_Hosp_Profee_Price Antithrombin Antigen LC 8447673 CDM 301 RC facility both 8.15 8.15 Gross Charge Type: NIHD_Hosp_Profee_Price Antithrombin Antigen LC 8447673 CDM 301 RC facility both 8.15 8.15 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone, Total, Women, Children, and Hypogonadal Males, LC/MS-MS LC" 8447681 CDM 300 RC facility both 6.65 6.65 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone, Total, Women, Children, and Hypogonadal Males, LC/MS-MS LC" 8447681 CDM 300 RC facility both 6.65 6.65 Gross Charge Type: NIHD_Hosp_Profee_Price "AChR Binding Abs, Serum LC" 8447688 CDM 301 RC facility both 11.4 11.4 Gross Charge Type: NIHD_Hosp_Profee_Price "AChR Binding Abs, Serum LC" 8447688 CDM 301 RC facility both 11.4 11.4 Gross Charge Type: NIHD_Hosp_Profee_Price "Salivary Cortisol,MS LC" 8447749 CDM 301 RC facility both 123.8 123.8 Gross Charge Type: NIHD_Hosp_Profee_Price "Salivary Cortisol,MS LC" 8447749 CDM 301 RC facility both 123.8 123.8 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone, Free/Tot Equilib LC" 8447788 CDM 301 RC facility both 26.78 26.78 Gross Charge Type: NIHD_Hosp_Profee_Price "Testosterone, Free/Tot Equilib LC" 8447788 CDM 301 RC facility both 26.78 26.78 Gross Charge Type: NIHD_Hosp_Profee_Price Triglycerides 84478 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Triglycerides 84478 CDM 301 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price "H. pylori, IgM, IgG, IgA Ab LC" 8447804 CDM 302 RC facility both 17.31 17.31 Gross Charge Type: NIHD_Hosp_Profee_Price "H. pylori, IgM, IgG, IgA Ab LC" 8447804 CDM 302 RC facility both 17.31 17.31 Gross Charge Type: NIHD_Hosp_Profee_Price "Folate, RBC LC" 8447818 CDM 301 RC facility both 5.1 5.1 Gross Charge Type: NIHD_Hosp_Profee_Price "Folate, RBC LC" 8447818 CDM 301 RC facility both 5.1 5.1 Gross Charge Type: NIHD_Hosp_Profee_Price "IFE+Protein Electro, 24-Hr Ur LC" 8447837 CDM 301 RC facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price "IFE+Protein Electro, 24-Hr Ur LC" 8447837 CDM 301 RC facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price "Heavy Metals Profile, Urine LC" 8447842 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "Heavy Metals Profile, Urine LC" 8447842 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price T3 Uptake LC 84479 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price T3 Uptake LC 84479 CDM 301 RC facility both 2.25 2.25 Gross Charge Type: NIHD_Hosp_Profee_Price HNK1 (CD57) Panel LC 8447914 CDM 301 RC facility both 34 34 Gross Charge Type: NIHD_Hosp_Profee_Price HNK1 (CD57) Panel LC 8447914 CDM 301 RC facility both 34 34 Gross Charge Type: NIHD_Hosp_Profee_Price Triiodothyronine (T3) LC 84480 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price Triiodothyronine (T3) LC 84480 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price .T3Free LC 8448111 CDM 301 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price .T3Free LC 8448111 CDM 301 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price T3 Free 8448112 CDM 301 RC facility both 191 191 Gross Charge Type: NIHD_Hosp_Profee_Price T3 Free 8448112 CDM 301 RC facility both 191 191 Gross Charge Type: NIHD_Hosp_Profee_Price "Triiodothyronine (T3), Free LC" 844812 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Triiodothyronine (T3), Free LC" 844812 CDM 301 RC facility both 4 4 Gross Charge Type: NIHD_Hosp_Profee_Price "Reverse T3, Serum LC" 84482 CDM 301 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price "Reverse T3, Serum LC" 84482 CDM 301 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price Troponin-I 84484 CDM 301 RC facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price Troponin-I 84484 CDM 301 RC facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Urea Nitrogen 84520 CDM 301 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Urea Nitrogen 84520 CDM 301 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price CMV Abs IgG/IgM LC 8453207 CDM 301 RC facility both 8.88 8.88 Gross Charge Type: NIHD_Hosp_Profee_Price CMV Abs IgG/IgM LC 8453207 CDM 301 RC facility both 8.88 8.88 Gross Charge Type: NIHD_Hosp_Profee_Price Diabetes Autoimmune Profile LC 8453223 CDM 301 RC facility both 164.89 164.89 Gross Charge Type: NIHD_Hosp_Profee_Price Diabetes Autoimmune Profile LC 8453223 CDM 301 RC facility both 164.89 164.89 Gross Charge Type: NIHD_Hosp_Profee_Price OmegaCheck(TM) (EPA+DPA+DHA) LC 8453230 CDM 301 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price OmegaCheck(TM) (EPA+DPA+DHA) LC 8453230 CDM 301 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "Chromium and Cobalt, WB (MoM) LC" 8453251 CDM 301 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "Chromium and Cobalt, WB (MoM) LC" 8453251 CDM 301 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price IA-2 Autoantibodies LC 8453271 CDM 300 RC facility both 50.5 50.5 Gross Charge Type: NIHD_Hosp_Profee_Price IA-2 Autoantibodies LC 8453271 CDM 300 RC facility both 50.5 50.5 Gross Charge Type: NIHD_Hosp_Profee_Price Protein S-Functional LC 8453286 CDM 301 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price Protein S-Functional LC 8453286 CDM 301 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price Uric Acid 84550 CDM 301 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price Uric Acid 84550 CDM 301 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcium, Ur LC" 845601 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price "Calcium, Ur LC" 845601 CDM 301 RC facility both 6.43 6.43 Gross Charge Type: NIHD_Hosp_Profee_Price "Uric Acid, 24 hr Urine LC" 845602 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price "Uric Acid, 24 hr Urine LC" 845602 CDM 301 RC facility both 2 2 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin A LC 84590_1 CDM 300 RC facility both 9.11 9.11 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin A LC 84590_1 CDM 300 RC facility both 9.11 9.11 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin A, Serum LC" 84590_2 CDM 300 RC facility both 9.5 9.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Vitamin A, Serum LC" 84590_2 CDM 300 RC facility both 9.5 9.5 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B3 (Niacin+Metabolite) LC 84591 CDM 301 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin B3 (Niacin+Metabolite) LC 84591 CDM 301 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin K1 LC 84597 CDM 300 RC facility both 12.14 12.14 Gross Charge Type: NIHD_Hosp_Profee_Price Vitamin K1 LC 84597 CDM 300 RC facility both 12.14 12.14 Gross Charge Type: NIHD_Hosp_Profee_Price Osmolality LC 84630 CDM 301 RC facility both 18.36 18.36 Gross Charge Type: NIHD_Hosp_Profee_Price Osmolality LC 84630 CDM 301 RC facility both 18.36 18.36 Gross Charge Type: NIHD_Hosp_Profee_Price "C-Peptide, Serum LC" 846811 CDM 301 RC facility both 3.65 3.65 Gross Charge Type: NIHD_Hosp_Profee_Price "C-Peptide, Serum LC" 846811 CDM 301 RC facility both 3.65 3.65 Gross Charge Type: NIHD_Hosp_Profee_Price Insulin LC 846812 CDM 301 RC facility both 3.51 3.51 Gross Charge Type: NIHD_Hosp_Profee_Price Insulin LC 846812 CDM 301 RC facility both 3.51 3.51 Gross Charge Type: NIHD_Hosp_Profee_Price Beta hCG Quantitative 8470211 CDM 301 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price Beta hCG Quantitative 8470211 CDM 301 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price "hCG,Beta Subunit Qnt, U LC" 8470212 CDM 301 RC facility both 16.32 16.32 Gross Charge Type: NIHD_Hosp_Profee_Price "hCG,Beta Subunit Qnt, U LC" 8470212 CDM 301 RC facility both 16.32 16.32 Gross Charge Type: NIHD_Hosp_Profee_Price "hCG, Beta Subunit, Qn (Serial) LC" 847022 CDM 301 RC facility both 11.04 11.04 Gross Charge Type: NIHD_Hosp_Profee_Price "hCG, Beta Subunit, Qn (Serial) LC" 847022 CDM 301 RC facility both 11.04 11.04 Gross Charge Type: NIHD_Hosp_Profee_Price Pregnancy Test Serum Qual 847031 CDM 301 RC facility both 257 257 Gross Charge Type: NIHD_Hosp_Profee_Price Pregnancy Test Serum Qual 847031 CDM 301 RC facility both 257 257 Gross Charge Type: NIHD_Hosp_Profee_Price "hCG,Beta Subunit Ql, S LC" 847032 CDM 302 RC facility both 2.95 2.95 Gross Charge Type: NIHD_Hosp_Profee_Price "hCG,Beta Subunit Ql, S LC" 847032 CDM 302 RC facility both 2.95 2.95 Gross Charge Type: NIHD_Hosp_Profee_Price "Gastrin, Serum LC" 8473214 CDM 301 RC facility both 4.72 4.72 Gross Charge Type: NIHD_Hosp_Profee_Price "Gastrin, Serum LC" 8473214 CDM 301 RC facility both 4.72 4.72 Gross Charge Type: NIHD_Hosp_Profee_Price "AChR Blocking Abs, Serum LC" 8473232 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price "AChR Blocking Abs, Serum LC" 8473232 CDM 301 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunofixation, Urine LC" 8473239 CDM 302 RC facility both 16.18 16.18 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunofixation, Urine LC" 8473239 CDM 302 RC facility both 16.18 16.18 Gross Charge Type: NIHD_Hosp_Profee_Price Striational Antibodies LC 8473247 CDM 301 RC facility both 8.99 8.99 Gross Charge Type: NIHD_Hosp_Profee_Price Striational Antibodies LC 8473247 CDM 301 RC facility both 8.99 8.99 Gross Charge Type: NIHD_Hosp_Profee_Price Apolipoprotein B LC 8473256 CDM 301 RC facility both 6.72 6.72 Gross Charge Type: NIHD_Hosp_Profee_Price Apolipoprotein B LC 8473256 CDM 301 RC facility both 6.72 6.72 Gross Charge Type: NIHD_Hosp_Profee_Price "Cyclospora Smear, Stool LC" 8473257 CDM 301 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Cyclospora Smear, Stool LC" 8473257 CDM 301 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price G006-IgE Timothy Grass LC 8473267 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price G006-IgE Timothy Grass LC 8473267 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price Platelet Antibody Profile LC 8473301 CDM 301 RC facility both 41.21 41.21 Gross Charge Type: NIHD_Hosp_Profee_Price Platelet Antibody Profile LC 8473301 CDM 301 RC facility both 41.21 41.21 Gross Charge Type: NIHD_Hosp_Profee_Price Protein S-Antigen LC 8473322 CDM 301 RC facility both 32 32 Gross Charge Type: NIHD_Hosp_Profee_Price Protein S-Antigen LC 8473322 CDM 301 RC facility both 32 32 Gross Charge Type: NIHD_Hosp_Profee_Price Antithrombin Activity LC 8474129 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Antithrombin Activity LC 8474129 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Activated Protein C Resistance LC 8474132 CDM 300 RC facility both 18.25 18.25 Gross Charge Type: NIHD_Hosp_Profee_Price Activated Protein C Resistance LC 8474132 CDM 300 RC facility both 18.25 18.25 Gross Charge Type: NIHD_Hosp_Profee_Price FVDNA TRACKING LC 8474133 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price FVDNA TRACKING LC 8474133 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT LC 8474135 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT LC 8474135 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Lupus Rfx Interp LC 8474136 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Lupus Rfx Interp LC 8474136 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Dilute Prothrombin Time(dPT) LC 8474137 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Dilute Prothrombin Time(dPT) LC 8474137 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price dPT Confirm Ratio LC 8474138 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price dPT Confirm Ratio LC 8474138 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgG Ab LC 8474139 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgG Ab LC 8474139 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgM Ab LC 8474140 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgM Ab LC 8474140 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Glycoprotein I Ab, IgG LC" 8474141 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Glycoprotein I Ab, IgG LC" 8474141 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Glycoprotein I Ab, IgM LC" 8474142 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Glycoprotein I Ab, IgM LC" 8474142 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "Factor II, DNA Analysis: LC" 8474143 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "Factor II, DNA Analysis: LC" 8474143 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price "Osmolality, Fecal LC" 84999_1 CDM 301 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price "Osmolality, Fecal LC" 84999_1 CDM 301 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price TMAO (Trimethylamine N-oxide) LC 123413 84999_2 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price TMAO (Trimethylamine N-oxide) LC 123413 84999_2 CDM 301 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price "Electrolytes, Fecal LC" 849991 CDM 301 RC facility both 80.35 80.35 Gross Charge Type: NIHD_Hosp_Profee_Price "Electrolytes, Fecal LC" 849991 CDM 301 RC facility both 80.35 80.35 Gross Charge Type: NIHD_Hosp_Profee_Price Automated Differential 850041 CDM 305 RC facility both 48.41 48.41 Gross Charge Type: NIHD_Hosp_Profee_Price Automated Differential 850041 CDM 305 RC facility both 48.41 48.41 Gross Charge Type: NIHD_Hosp_Profee_Price .Manual Differential (NIHD) 850071 CDM 305 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price .Manual Differential (NIHD) 850071 CDM 305 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price .Morphology (NIHD) 850081 CDM 305 RC facility both 41 41 Gross Charge Type: NIHD_Hosp_Profee_Price .Morphology (NIHD) 850081 CDM 305 RC facility both 41 41 Gross Charge Type: NIHD_Hosp_Profee_Price Hematocrit 85014 CDM 300 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Hematocrit 85014 CDM 300 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Hemoglobin POCT 85018 CDM 521 RC 85018 HCPCS facility both 47 47 Gross Charge Type: NIHD_RHC_Price Hemoglobin POCT 85018 CDM 521 RC 85018 HCPCS facility both 47 47 Gross Charge Type: NIHD_Clinic_Price Hemoglobin POCT 85018 CDM 300 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Hemoglobin POCT 85018 CDM 300 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Hemoglobin A1c POC (RE) 850182 CDM 85018 HCPCS facility both 34 34 Gross Charge Type: NIHD_RHC_Price Hemoglobin A1c POC (RE) 850182 CDM 85018 HCPCS facility both 34 34 Gross Charge Type: NIHD_Clinic_Price Hemoglobin 850183 CDM 300 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price Hemoglobin 850183 CDM 300 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price CBC w/ Differential 850251 CDM 85027 HCPCS facility both 125 125 Gross Charge Type: NIHD_RHC_Price CBC w/ Differential 850251 CDM 85027 HCPCS facility both 125 125 Gross Charge Type: NIHD_Clinic_Price CBC w/ Differential 850251 CDM 305 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price CBC w/ Differential 850251 CDM 305 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price CBC w/ Differential LC 850252 CDM 300 RC facility both 9.93 9.93 Gross Charge Type: NIHD_Hosp_Profee_Price CBC w/ Differential LC 850252 CDM 300 RC facility both 9.93 9.93 Gross Charge Type: NIHD_Hosp_Profee_Price CBC w/ Manual Differential 850271 CDM 305 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price CBC w/ Manual Differential 850271 CDM 305 RC facility both 129 129 Gross Charge Type: NIHD_Hosp_Profee_Price CBC without Differential 850272 CDM 305 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price CBC without Differential 850272 CDM 305 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price Flex Sigmoidoscopy w/Screening 8503369 CDM 360 RC facility both 3519 3519 Gross Charge Type: NIHD_Hosp_Profee_Price Flex Sigmoidoscopy w/Screening 8503369 CDM 360 RC facility both 3519 3519 Gross Charge Type: NIHD_Hosp_Profee_Price "G-6-PD, Qnt LC" 85041 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price "G-6-PD, Qnt LC" 85041 CDM 301 RC facility both 3.67 3.67 Gross Charge Type: NIHD_Hosp_Profee_Price Reticulocyte Count LC 85045 CDM 305 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price Reticulocyte Count LC 85045 CDM 305 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price Retic Count % 850451_1 CDM 305 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price Retic Count % 850451_1 CDM 305 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price Retic Count Automated 850451_2 CDM 305 RC facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price Retic Count Automated 850451_2 CDM 305 RC facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price Reticulocyte Count Automated 850452 CDM 305 RC facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price Reticulocyte Count Automated 850452 CDM 305 RC facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price Platelet Count 85049 CDM 305 RC facility both TC 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price Platelets 85049_305 CDM 305 RC facility both 796.64 796.64 Gross Charge Type: NIHD_Hosp_Profee_Price Platelets 85049_305 CDM 305 RC facility both 796.64 796.64 Gross Charge Type: NIHD_Hosp_Profee_Price Aph Plt ACDA LR Bm 85049_390 CDM 390 RC facility both 685 685 Gross Charge Type: NIHD_Hosp_Profee_Price Aph Plt ACDA LR Bm 85049_390 CDM 390 RC facility both 685 685 Gross Charge Type: NIHD_Hosp_Profee_Price E3046 Aph Plt ACDA LR Irr 85049_E3046 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price E3046 Aph Plt ACDA LR Irr 85049_E3046 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price E3056 Aph Plt ACDA LR Irr 1 85049_E3056 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price Platelet Count 85049_TC CDM 305 RC facility both TC 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price 85060 AP Bill Peripheral Smear with Path Interp 85060 CDM 971 RC 85060 HCPCS facility both 26 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price 85060 AP Bill Peripheral Smear with Path Interp 85060 CDM 971 RC 85060 HCPCS facility both 26 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price Factor VIII Activity LC 85240 CDM 301 RC facility both 38.94 38.94 Gross Charge Type: NIHD_Hosp_Profee_Price Factor VIII Activity LC 85240 CDM 301 RC facility both 38.94 38.94 Gross Charge Type: NIHD_Hosp_Profee_Price vWF Activity LC 85245 CDM 301 RC facility both 38.94 38.94 Gross Charge Type: NIHD_Hosp_Profee_Price vWF Activity LC 85245 CDM 301 RC facility both 38.94 38.94 Gross Charge Type: NIHD_Hosp_Profee_Price von Willebrand Factor (vWF) Ag LC 85246 CDM 301 RC facility both 38.94 38.94 Gross Charge Type: NIHD_Hosp_Profee_Price von Willebrand Factor (vWF) Ag LC 85246 CDM 301 RC facility both 38.94 38.94 Gross Charge Type: NIHD_Hosp_Profee_Price Antithrombin Activity LC 85300 CDM 301 RC facility both 14.5 14.5 Gross Charge Type: NIHD_Hosp_Profee_Price Antithrombin Activity LC 85300 CDM 301 RC facility both 14.5 14.5 Gross Charge Type: NIHD_Hosp_Profee_Price Protein C Ag LC 85302 CDM 305 RC facility both 9.5 9.5 Gross Charge Type: NIHD_Hosp_Profee_Price Protein C Ag LC 85302 CDM 305 RC facility both 9.5 9.5 Gross Charge Type: NIHD_Hosp_Profee_Price Protein C-Functional LC 85303_1 CDM 305 RC facility both 9.49 9.49 Gross Charge Type: NIHD_Hosp_Profee_Price Protein C-Functional LC 85303_2 CDM 305 RC facility both 14.1 14.1 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein S, Free LC" 85305 CDM 301 RC facility both 14.74 14.74 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein S, Free LC" 85305 CDM 301 RC facility both 14.74 14.74 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein S, Total LC" 85306_301 CDM 301 RC facility both 14.74 14.74 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein S, Total LC" 85306_301 CDM 301 RC facility both 14.74 14.74 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein S, Free LC" 85306_305 CDM 305 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein S, Free LC" 85306_305 CDM 305 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price D-Dimer 85378 CDM 305 RC facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price D-Dimer 85378 CDM 305 RC facility both 293 293 Gross Charge Type: NIHD_Hosp_Profee_Price Fibrinogen Level 85384 CDM 305 RC facility both 244 244 Gross Charge Type: NIHD_Hosp_Profee_Price Fibrinogen Level 85384 CDM 305 RC facility both 244 244 Gross Charge Type: NIHD_Hosp_Profee_Price Homocyst(e)ine LC 8541361 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Homocyst(e)ine LC 8541361 CDM 300 RC facility both 18 18 Gross Charge Type: NIHD_Hosp_Profee_Price Kleihauer-Betke 85460 CDM 300 RC facility both 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price Kleihauer-Betke 85460 CDM 300 RC facility both 220 220 Gross Charge Type: NIHD_Hosp_Profee_Price Fetal Screen 85461 CDM 300 RC facility both 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price Fetal Screen 85461 CDM 300 RC facility both 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price .Hex Phase Phospholipid LC 855981 CDM 300 RC facility both 33.72 33.72 Gross Charge Type: NIHD_Hosp_Profee_Price .Hex Phase Phospholipid LC 855981 CDM 300 RC facility both 33.72 33.72 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgG LC 855982 CDM 305 RC facility both 30.79 30.79 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgG LC 855982 CDM 305 RC facility both 30.79 30.79 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgM Ab LC 855983 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgM Ab LC 855983 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price Thrombin Time LC 855984 CDM 305 RC facility both 15.2 15.2 Gross Charge Type: NIHD_Hosp_Profee_Price Thrombin Time LC 855984 CDM 305 RC facility both 15.2 15.2 Gross Charge Type: NIHD_Hosp_Profee_Price Hex Phospholipid Neut LC 856101 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price Hex Phospholipid Neut LC 856101 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price Prothrombin Time and INR 856102 CDM 305 RC facility both 148 148 Gross Charge Type: NIHD_Hosp_Profee_Price Prothrombin Time and INR 856102 CDM 305 RC facility both 148 148 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT LC 856103 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT LC 856103 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price .dRVVT Confirm 117924 LC 856131 CDM 305 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price .dRVVT Confirm 117924 LC 856131 CDM 305 RC facility both 30 30 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgM LC 856132 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgM LC 856132 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgA LC 856133 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgA LC 856133 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Hex Phase Phospho LC 856134 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price Hex Phase Phospho LC 856134 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price Thrombin Time LC 856135 CDM 305 RC facility both 11.25 11.25 Gross Charge Type: NIHD_Hosp_Profee_Price Thrombin Time LC 856135 CDM 305 RC facility both 11.25 11.25 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Conf Sec LC 856136 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Conf Sec LC 856136 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Scr Sec LC 856137 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Scr Sec LC 856137 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price Sedimentation Rate (ESR) 85652 CDM 305 RC facility both 142 142 Gross Charge Type: NIHD_Hosp_Profee_Price Sedimentation Rate (ESR) 85652 CDM 305 RC facility both 142 142 Gross Charge Type: NIHD_Hosp_Profee_Price Sickle Cell Screen 85660 CDM 305 RC facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price Sickle Cell Screen 85660 CDM 305 RC facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price .TT Mix+TTN LC 856701 CDM 305 RC facility both 29.32 29.32 Gross Charge Type: NIHD_Hosp_Profee_Price .TT Mix+TTN LC 856701 CDM 305 RC facility both 29.32 29.32 Gross Charge Type: NIHD_Hosp_Profee_Price .Thrombin Neutralization LC 856702 CDM 305 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price .Thrombin Neutralization LC 856702 CDM 305 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgG Ab LC 856703 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgG Ab LC 856703 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT LC 856704 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT LC 856704 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT LC 856705 CDM 305 RC facility both 11.25 11.25 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT LC 856705 CDM 305 RC facility both 11.25 11.25 Gross Charge Type: NIHD_Hosp_Profee_Price dPT Confirm Ratio LC 85705 CDM 305 RC facility both 11.25 11.25 Gross Charge Type: NIHD_Hosp_Profee_Price dPT Confirm Ratio LC 85705 CDM 305 RC facility both 11.25 11.25 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgA LC 857305 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgA LC 857305 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Glycoprotein I Ab, IgG LC" 857306 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Glycoprotein I Ab, IgG LC" 857306 CDM 305 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price Partial Thromboplastin Time 857307 CDM 305 RC facility both 255 255 Gross Charge Type: NIHD_Hosp_Profee_Price Partial Thromboplastin Time 857307 CDM 305 RC facility both 255 255 Gross Charge Type: NIHD_Hosp_Profee_Price Prothrombin Time LC 857308 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price Prothrombin Time LC 857308 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price .PTT-LA Mix LC 857321 CDM 305 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price .PTT-LA Mix LC 857321 CDM 305 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price .aPTT 1:1 Norm Plas LC 857322 CDM 305 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price .aPTT 1:1 Norm Plas LC 857322 CDM 305 RC facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price .PTT-LA Incub Mix LC 857323 CDM 305 RC facility both 53.76 53.76 Gross Charge Type: NIHD_Hosp_Profee_Price .PTT-LA Incub Mix LC 857323 CDM 305 RC facility both 53.76 53.76 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgG LC 857324 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgG LC 857324 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgM LC 857325 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgM LC 857325 CDM 305 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price Dilute Prothrombin Time(dPT) LC 857326 CDM 305 RC facility both 11.25 11.25 Gross Charge Type: NIHD_Hosp_Profee_Price Dilute Prothrombin Time(dPT) LC 857326 CDM 305 RC facility both 11.25 11.25 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT 1:1 Norm Plas LC 857327 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT 1:1 Norm Plas LC 857327 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT LC 857328 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT LC 857328 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price "Viscosity, Serum LC" 85810 CDM 305 RC facility both 10.49 10.49 Gross Charge Type: NIHD_Hosp_Profee_Price "Viscosity, Serum LC" 85810 CDM 305 RC facility both 10.49 10.49 Gross Charge Type: NIHD_Hosp_Profee_Price "86003 HVA With Components Profile, II LC 606895" 86003 CDM 301 RC 86003 HCPCS facility both 5.42 5.42 Gross Charge Type: NIHD_Hosp_Profee_Price "86003 HVA With Components Profile, II LC 606895" 86003 CDM 301 RC 86003 HCPCS facility both 5.42 5.42 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile, Food-Basic LC" 860031 CDM 300 RC facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile, Food-Basic LC" 860031 CDM 300 RC facility both 19.56 19.56 Gross Charge Type: NIHD_Hosp_Profee_Price G002-IgE Bermuda Grass LC 8600310 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price G002-IgE Bermuda Grass LC 8600310 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price G006-IgE Timothy Grass LC 8600311 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price G006-IgE Timothy Grass LC 8600311 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price G006-IgE Timothy Grass LC 8600312 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price G006-IgE Timothy Grass LC 8600312 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price G010-IgE Johnson Grass LC 8600313 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price G010-IgE Johnson Grass LC 8600313 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "I006-IgE Cockroach, German LC" 8600314 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "I006-IgE Cockroach, German LC" 8600314 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "I006-IgE Cockroach, German LC" 8600315 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "I006-IgE Cockroach, German LC" 8600315 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin E, Ttl LC" 8600316 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin E, Ttl LC" 8600316 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin E, Ttl LC" 8600317 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin E, Ttl LC" 8600317 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M001-IgE Penicillium chrysogen LC 8600318 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M001-IgE Penicillium chrysogen LC 8600318 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M001-IgE Penicillium chrysogen LC 8600319 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M001-IgE Penicillium chrysogen LC 8600319 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M002-IgE Cladosporium herbarum LC 8600320 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M002-IgE Cladosporium herbarum LC 8600320 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M002-IgE Cladosporium herbarum LC 8600321 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M002-IgE Cladosporium herbarum LC 8600321 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M003-IgE Aspergillus fumigatus LC 8600322 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M003-IgE Aspergillus fumigatus LC 8600322 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M003-IgE Aspergillus fumigatus LC 8600323 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M003-IgE Aspergillus fumigatus LC 8600323 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M006-IgE Alternaria alternata LC 8600324 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M006-IgE Alternaria alternata LC 8600324 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M006-IgE Alternaria alternata LC 8600325 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M006-IgE Alternaria alternata LC 8600325 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T002-IgE Alder, Grey LC" 8600326 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T002-IgE Alder, Grey LC" 8600326 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T002-IgE Alder, Grey LC" 8600327 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T002-IgE Alder, Grey LC" 8600327 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T003-IgE Common Silver Birch LC 8600328 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T003-IgE Common Silver Birch LC 8600328 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T006-IgE Cedar, Mountain LC" 8600329 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T006-IgE Cedar, Mountain LC" 8600329 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T006-IgE Cedar, Mountain LC" 8600330 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T006-IgE Cedar, Mountain LC" 8600330 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T007-IgE Oak, White LC" 8600331 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T007-IgE Oak, White LC" 8600331 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T008-IgE Elm, American LC" 8600332 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T008-IgE Elm, American LC" 8600332 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T008-IgE Elm, American LC" 8600333 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "T008-IgE Elm, American LC" 8600333 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T009-IgE Olive Tree LC 8600334 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T009-IgE Olive Tree LC 8600334 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T009-IgE Olive Tree LC 8600335 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T009-IgE Olive Tree LC 8600335 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T010-IgE Walnut LC 8600336 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T010-IgE Walnut LC 8600336 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T011-IgE Maple Leaf Sycamore LC 8600337 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T011-IgE Maple Leaf Sycamore LC 8600337 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T014-IgE Cottonwood LC 8600338 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T014-IgE Cottonwood LC 8600338 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T070-IgE White Mulberry LC 8600339 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T070-IgE White Mulberry LC 8600339 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T070-IgE White Mulberry LC 8600340 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T070-IgE White Mulberry LC 8600340 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "W001-IgE Ragweed, Short LC" 8600341 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "W001-IgE Ragweed, Short LC" 8600341 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "W001-IgE Ragweed, Short LC" 8600342 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "W001-IgE Ragweed, Short LC" 8600342 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price W006-IgE Mugwort LC 8600343 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price W006-IgE Mugwort LC 8600343 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price W006-IgE Mugwort LC 8600344 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price W006-IgE Mugwort LC 8600344 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price W011-IgE Thistle Russian LC 8600345 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price W011-IgE Thistle Russian LC 8600345 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price W011-IgE Thistle Russian LC 8600346 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price W011-IgE Thistle Russian LC 8600346 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "W014-IgE Pigweed, Common LC" 8600347 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "W014-IgE Pigweed, Common LC" 8600347 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price D001-IgE D pteronyssinus LC 8600348 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price D001-IgE D pteronyssinus LC 8600348 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price E072-IgE Mouse Urine LC 8600349 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price E072-IgE Mouse Urine LC 8600349 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price G002-IgE Bermuda Grass LC 8600350 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price G002-IgE Bermuda Grass LC 8600350 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile, Latex Plus LC" 8600351 CDM 300 RC facility both 16.3 16.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile, Latex Plus LC" 8600351 CDM 300 RC facility both 16.3 16.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile, Food-Citrus LC" 8600352 CDM 300 RC facility both 9.78 9.78 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile, Food-Citrus LC" 8600352 CDM 300 RC facility both 9.78 9.78 Gross Charge Type: NIHD_Hosp_Profee_Price D001-IgE D pteronyssinus LC 8600353 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price D001-IgE D pteronyssinus LC 8600353 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile, Mold LC" 8600354 CDM 300 RC facility both 39.12 39.12 Gross Charge Type: NIHD_Hosp_Profee_Price "Allergen Profile, Mold LC" 8600354 CDM 300 RC facility both 39.12 39.12 Gross Charge Type: NIHD_Hosp_Profee_Price D002-IgE D farinae LC 8600355 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price D002-IgE D farinae LC 8600355 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price D002-IgE D farinae LC 8600356 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price D002-IgE D farinae LC 8600356 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price Food Allergy Profile LC 8600357 CDM 300 RC facility both 39.12 39.12 Gross Charge Type: NIHD_Hosp_Profee_Price Food Allergy Profile LC 8600357 CDM 300 RC facility both 39.12 39.12 Gross Charge Type: NIHD_Hosp_Profee_Price E001-IgE Cat Dander LC 8600358 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price E001-IgE Cat Dander LC 8600358 CDM 300 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price IgE Food w/Component Reflex II LC 8600359 CDM 300 RC facility both 58.68 58.68 Gross Charge Type: NIHD_Hosp_Profee_Price IgE Food w/Component Reflex II LC 8600359 CDM 300 RC facility both 58.68 58.68 Gross Charge Type: NIHD_Hosp_Profee_Price E001-IgE Cat Dander LC 860036 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price E001-IgE Cat Dander LC 860036 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price T001-IgE Maple/Box Elder LC 8600360 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T001-IgE Maple/Box Elder LC 8600360 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T009-IgE Olive Tree LC 8600361 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T009-IgE Olive Tree LC 8600361 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T014-IgE Cottonwood LC 8600362 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price T014-IgE Cottonwood LC 8600362 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price W011-IgE Thistle Russian LC 8600363 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price W011-IgE Thistle Russian LC 8600363 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price E072-IgE Mouse Urine LC 8600364 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price E072-IgE Mouse Urine LC 8600364 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price E001-IgE Cat Dander LC 8600365 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price E001-IgE Cat Dander LC 8600365 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price W006-IgE Mugwort LC 8600366 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price W006-IgE Mugwort LC 8600366 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "T007-IgE Oak, White LC" 8600367 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price "T007-IgE Oak, White LC" 8600367 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price "T008-IgE Elm, American LC" 8600368 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price "T008-IgE Elm, American LC" 8600368 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price D002-IgE D farinae LC 8600369 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price D002-IgE D farinae LC 8600369 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price E005-IgE Dog Dander LC 860037 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price E005-IgE Dog Dander LC 860037 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M002-IgE Cladosporium herbarum LC 8600370 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price M002-IgE Cladosporium herbarum LC 8600370 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price E005-IgE Dog Dander LC 8600371 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price E005-IgE Dog Dander LC 8600371 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price D001-IgE D pteronyssinus LC 8600372 CDM 302 RC facility both 3.33 3.33 Gross Charge Type: NIHD_Hosp_Profee_Price D001-IgE D pteronyssinus LC 8600372 CDM 302 RC facility both 3.33 3.33 Gross Charge Type: NIHD_Hosp_Profee_Price "I006-IgE Cockroach, German LC" 8600373 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "I006-IgE Cockroach, German LC" 8600373 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price G006-IgE Timothy Grass LC 8600374 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price G006-IgE Timothy Grass LC 8600374 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "T006-IgE Cedar, Mountain LC" 8600375 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "T006-IgE Cedar, Mountain LC" 8600375 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "W001-IgE Ragweed, Short LC" 8600376 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "W001-IgE Ragweed, Short LC" 8600376 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "W014-IgE Pigweed, Common LC" 8600377 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "W014-IgE Pigweed, Common LC" 8600377 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price M001-IgE Penicillium chrysogen LC 8600378 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price M001-IgE Penicillium chrysogen LC 8600378 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price M006-IgE Alternaria alternata LC 8600379 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price M006-IgE Alternaria alternata LC 8600379 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price E005-IgE Dog Dander LC 860038 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price E005-IgE Dog Dander LC 860038 CDM 302 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price M003-IgE Aspergillus fumigatus LC 8600380 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price M003-IgE Aspergillus fumigatus LC 8600380 CDM 302 RC facility both 3.45 3.45 Gross Charge Type: NIHD_Hosp_Profee_Price G002-IgE Bermuda Grass LC 8600381 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price G002-IgE Bermuda Grass LC 8600381 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T070-IgE White Mulberry LC 8600382 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price T070-IgE White Mulberry LC 8600382 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price E072-IgE Mouse Urine LC 860039 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price E072-IgE Mouse Urine LC 860039 CDM 300 RC facility both 3.3 3.3 Gross Charge Type: NIHD_Hosp_Profee_Price "86008 HVA With Components Profile, II LC 606895" 86008_301 CDM 301 RC 86008 HCPCS facility both 5.42 5.42 Gross Charge Type: NIHD_Hosp_Profee_Price "86008 HVA With Components Profile, II LC 606895" 86008_301 CDM 301 RC 86008 HCPCS facility both 5.42 5.42 Gross Charge Type: NIHD_Hosp_Profee_Price .Walnut 604721 LC 86008_302 CDM 302 RC facility both 11.34 11.34 Gross Charge Type: NIHD_Hosp_Profee_Price .Walnut 604721 LC 86008_302 CDM 302 RC facility both 11.34 11.34 Gross Charge Type: NIHD_Hosp_Profee_Price .Brazil Nut 604350 LC 860081 CDM 302 RC facility both 14.58 14.58 Gross Charge Type: NIHD_Hosp_Profee_Price .Brazil Nut 604350 LC 860081 CDM 302 RC facility both 14.58 14.58 Gross Charge Type: NIHD_Hosp_Profee_Price .Cashew 604239 LC 860082 CDM 302 RC facility both 14.58 14.58 Gross Charge Type: NIHD_Hosp_Profee_Price .Cashew 604239 LC 860082 CDM 302 RC facility both 14.58 14.58 Gross Charge Type: NIHD_Hosp_Profee_Price .Cat 606578 LC 860083 CDM 302 RC facility both 9.78 9.78 Gross Charge Type: NIHD_Hosp_Profee_Price .Cat 606578 LC 860083 CDM 302 RC facility both 9.78 9.78 Gross Charge Type: NIHD_Hosp_Profee_Price .Dog 606648 LC 860084 CDM 302 RC facility both 58.4 58.4 Gross Charge Type: NIHD_Hosp_Profee_Price .Dog 606648 LC 860084 CDM 302 RC facility both 58.4 58.4 Gross Charge Type: NIHD_Hosp_Profee_Price .Egg White Component LC 860085 CDM 302 RC facility both 7.52 7.52 Gross Charge Type: NIHD_Hosp_Profee_Price .Egg White Component LC 860085 CDM 302 RC facility both 7.52 7.52 Gross Charge Type: NIHD_Hosp_Profee_Price .Hazelnut 604726 LC 860086 CDM 302 RC facility both 36 36 Gross Charge Type: NIHD_Hosp_Profee_Price .Hazelnut 604726 LC 860086 CDM 302 RC facility both 36 36 Gross Charge Type: NIHD_Hosp_Profee_Price .Milk Components LC 860087 CDM 302 RC facility both 7.52 7.52 Gross Charge Type: NIHD_Hosp_Profee_Price .Milk Components LC 860087 CDM 302 RC facility both 7.52 7.52 Gross Charge Type: NIHD_Hosp_Profee_Price .Panel LC 860088 CDM 302 RC facility both 24.25 24.25 Gross Charge Type: NIHD_Hosp_Profee_Price .Panel LC 860088 CDM 302 RC facility both 24.25 24.25 Gross Charge Type: NIHD_Hosp_Profee_Price Antibody Screen Tube 860171 CDM 302 RC facility both 221 221 Gross Charge Type: NIHD_Hosp_Profee_Price Antibody Screen Tube 860171 CDM 302 RC facility both 221 221 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 28 86028 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price DRAIN MALLENCOT SIZE 28 86028 CDM 272 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price 86038 Scleroderma Comprehensive Plus Profile (RDL) 520130 86038 CDM 301 RC 86038 HCPCS facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price 86038 Scleroderma Comprehensive Plus Profile (RDL) 520130 86038 CDM 301 RC 86038 HCPCS facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price ANA LC 860381 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price ANA LC 860381 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 860382 CDM 302 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 860382 CDM 302 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price ANA w/Reflex if Positive LC 860383 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price ANA w/Reflex if Positive LC 860383 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price "Antinuclear Antibodies, IFA LC" 860384 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price "Antinuclear Antibodies, IFA LC" 860384 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price ANA w/Reflex EIA LC 860385_300 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price ANA w/Reflex EIA LC 860385_300 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price "Monkeypox (Orthopoxvirus), DNA, PCR LC" 860385_301 CDM 301 RC facility both 77 77 Gross Charge Type: NIHD_Hosp_Profee_Price "Monkeypox (Orthopoxvirus), DNA, PCR LC" 860385_301 CDM 301 RC facility both 77 77 Gross Charge Type: NIHD_Hosp_Profee_Price Antinuclear Antibodies Direct LC 860386 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price Antinuclear Antibodies Direct LC 860386 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price ABO Only 860821 CDM 302 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price ABO Only 860821 CDM 302 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price ABO Only 2 860822 CDM 302 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price ABO Only 2 860822 CDM 302 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price ABO/Rh 860823 CDM 302 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price ABO/Rh 860823 CDM 302 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price ABO/Rh 2 860824 CDM 302 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price ABO/Rh 2 860824 CDM 302 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price C-Reactive Protein 861401 CDM 300 RC facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price C-Reactive Protein 861401 CDM 300 RC facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price "C-Reactive Protein, Quant LC" 861402 CDM 300 RC facility both 9.2 9.2 Gross Charge Type: NIHD_Hosp_Profee_Price "C-Reactive Protein, Quant LC" 861402 CDM 300 RC facility both 9.2 9.2 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgA LC 861461 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgA LC 861461 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgG LC 861462 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgG LC 861462 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgM LC 861463 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgM LC 861463 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price PT LC 861464 CDM 300 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price PT LC 861464 CDM 300 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT 1:1 Saline LC 861465 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT 1:1 Saline LC 861465 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT: LC 861466 CDM 300 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT: LC 861466 CDM 300 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Conf Sec LC 861467 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Conf Sec LC 861467 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Scr Sec LC 861468 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Scr Sec LC 861468 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Anticardiolip Ab IgA/G/M Qn LC 861471 CDM 300 RC facility both 8.46 8.46 Gross Charge Type: NIHD_Hosp_Profee_Price Anticardiolip Ab IgA/G/M Qn LC 861471 CDM 300 RC facility both 8.46 8.46 Gross Charge Type: NIHD_Hosp_Profee_Price "Anticardiolipin Ab, IgG/M, Qn LC" 861472 CDM 300 RC facility both 5.64 5.64 Gross Charge Type: NIHD_Hosp_Profee_Price "Anticardiolipin Ab, IgG/M, Qn LC" 861472 CDM 300 RC facility both 5.64 5.64 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgG LC 861473 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Cardiolipin IgG LC 861473 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Hex Phospholipid Neut LC 861474 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Hex Phospholipid Neut LC 861474 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price INR LC 861475 CDM 300 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price INR LC 861475 CDM 300 RC facility both 6.57 6.57 Gross Charge Type: NIHD_Hosp_Profee_Price Plt Neutralization LC 861476 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Plt Neutralization LC 861476 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Thrombin Time LC 861477 CDM 300 RC facility both 6.6 6.6 Gross Charge Type: NIHD_Hosp_Profee_Price Thrombin Time LC 861477 CDM 300 RC facility both 6.6 6.6 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT 1:1 Norm Plas LC 861478 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT 1:1 Norm Plas LC 861478 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT 1:1 Saline LC 861479 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price aPTT 1:1 Saline LC 861479 CDM 300 RC facility both 15.3 15.3 Gross Charge Type: NIHD_Hosp_Profee_Price APS IgG LC 861481 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price APS IgG LC 861481 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price APS IgM LC 861482 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price APS IgM LC 861482 CDM 300 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Antiparietal Cell Antibody LC 861601_300 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Antiparietal Cell Antibody LC 861601_300 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Antiparietal Cell Antibody LC 861601_301 CDM 301 RC facility both 8.15 8.15 Gross Charge Type: NIHD_Hosp_Profee_Price Antiparietal Cell Antibody LC 861601_301 CDM 301 RC facility both 8.15 8.15 Gross Charge Type: NIHD_Hosp_Profee_Price "Complement C3, Serum LC" 861602 CDM 300 RC facility both 2.85 2.85 Gross Charge Type: NIHD_Hosp_Profee_Price "Complement C3, Serum LC" 861602 CDM 300 RC facility both 2.85 2.85 Gross Charge Type: NIHD_Hosp_Profee_Price "Complement C4, Serum LC" 861603 CDM 300 RC facility both 2.85 2.85 Gross Charge Type: NIHD_Hosp_Profee_Price "Complement C4, Serum LC" 861603 CDM 300 RC facility both 2.85 2.85 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 861604 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 861604 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price CCP Antibodies IgG/IgA LC 86200_300 CDM 300 RC facility both 10.12 10.12 Gross Charge Type: NIHD_Hosp_Profee_Price CCP Antibodies IgG/IgA LC 86200_300 CDM 300 RC facility both 10.12 10.12 Gross Charge Type: NIHD_Hosp_Profee_Price 86200 RheumAssure® LC 504509 86200_301 CDM 301 RC 86200 HCPCS facility both 14.37 14.37 Gross Charge Type: NIHD_Hosp_Profee_Price 86200 RheumAssure® LC 504509 86200_301 CDM 301 RC 86200 HCPCS facility both 14.37 14.37 Gross Charge Type: NIHD_Hosp_Profee_Price ULTRACLIP DUAL TRIGGER BREAST MARKER 862017D 8620171 CDM facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price ULTRACLIP DUAL TRIGGER BREAST MARKER 862017D 8620171 CDM facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 86225 CDM 305 RC facility both 4.63 4.63 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 86225 CDM 305 RC facility both 4.63 4.63 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Abs LC 862251 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Abs LC 862251 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8622510 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8622510 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8622511 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8622511 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8622512 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8622512 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price TPO Ab LC 8622513 CDM 300 RC facility both 5.31 5.31 Gross Charge Type: NIHD_Hosp_Profee_Price TPO Ab LC 8622513 CDM 300 RC facility both 5.31 5.31 Gross Charge Type: NIHD_Hosp_Profee_Price dsDNA Crithidia luciliae IFA LC 8622514 CDM 300 RC facility both 21.91 21.91 Gross Charge Type: NIHD_Hosp_Profee_Price dsDNA Crithidia luciliae IFA LC 8622514 CDM 300 RC facility both 21.91 21.91 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 8622515 CDM 300 RC facility both 4.96 4.96 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 8622515 CDM 300 RC facility both 4.96 4.96 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-dsDNA Antibodies LC 862252 CDM 300 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-dsDNA Antibodies LC 862252 CDM 300 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Abs LC 862253 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Abs LC 862253 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Abs LC 862254 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Abs LC 862254 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 862255 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 862255 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Antichromatin Abs LC 862257 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Antichromatin Abs LC 862257 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 862259 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 862259 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price 86235 Scleroderma Comprehensive Plus Profile (RDL) 520130 86235 CDM 301 RC 86235 HCPCS facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price 86235 Scleroderma Comprehensive Plus Profile (RDL) 520130 86235 CDM 301 RC 86235 HCPCS facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623511 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623511 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623512 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623512 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623513 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623513 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623514 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623514 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Mitochondrial (M2) Ab LC 8623515 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Mitochondrial (M2) Ab LC 8623515 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 8623516 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 8623516 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 8623517 CDM 300 RC facility both 4.96 4.96 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 8623517 CDM 300 RC facility both 4.96 4.96 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 8623518 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 8623518 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 8623519 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Abs LC 8623519 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Abs LC 862352 CDM 300 RC facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Abs LC 862352 CDM 300 RC facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623520 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623520 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8623521 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8623521 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623523 CDM 300 RC facility both 4.96 4.96 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623523 CDM 300 RC facility both 4.96 4.96 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8623524 CDM 300 RC facility both 4.96 4.96 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8623524 CDM 300 RC facility both 4.96 4.96 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623525 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623525 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8623526 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8623526 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623527 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623527 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8623528 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 8623528 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623529 CDM 300 RC facility both 7.14 7.14 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623529 CDM 300 RC facility both 7.14 7.14 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623530 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623530 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623531 CDM 300 RC facility both 4.94 4.94 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623531 CDM 300 RC facility both 4.94 4.94 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623532 CDM 300 RC facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623532 CDM 300 RC facility both 8.06 8.06 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623533 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 8623533 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Smith/RNP Abs LC 8623534 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Smith/RNP Abs LC 8623534 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Actin (Smooth Muscle) Ab LC 8623535 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Actin (Smooth Muscle) Ab LC 8623535 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Antibodies LC 8623536 CDM 300 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Centromere B Antibodies LC 8623536 CDM 300 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 8623537 CDM 302 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 8623537 CDM 302 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Antiextractable Nuclear Ag LC 8623538 CDM 300 RC facility both 9.54 9.54 Gross Charge Type: NIHD_Hosp_Profee_Price Antiextractable Nuclear Ag LC 8623538 CDM 300 RC facility both 9.54 9.54 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 LC 8623539 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 LC 8623539 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 862354 CDM 302 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-DNA DS Ab LC 862354 CDM 302 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 LC 8623540 CDM 300 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 LC 8623540 CDM 300 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 LC 8623541 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 LC 8623541 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623542 CDM 300 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Antiscleroderma-70 Abs LC 8623542 CDM 300 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Antichromatin Abs LC 8623543 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Antichromatin Abs LC 8623543 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Antibodies LC 8623544 CDM 300 RC facility both 4.77 4.77 Gross Charge Type: NIHD_Hosp_Profee_Price RNP Antibodies LC 8623544 CDM 300 RC facility both 4.77 4.77 Gross Charge Type: NIHD_Hosp_Profee_Price Antiribosomal P Abs LC 8623545 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price Antiribosomal P Abs LC 8623545 CDM 300 RC facility both 8.01 8.01 Gross Charge Type: NIHD_Hosp_Profee_Price "Sjogren's Ab, Anti-SS-A/-SS-B LC" 8623546 CDM 300 RC facility both 9.54 9.54 Gross Charge Type: NIHD_Hosp_Profee_Price "Sjogren's Ab, Anti-SS-A/-SS-B LC" 8623546 CDM 300 RC facility both 9.54 9.54 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623547 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 8623547 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Antibodies LC 8623548 CDM 300 RC facility both 4.77 4.77 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Antibodies LC 8623548 CDM 300 RC facility both 4.77 4.77 Gross Charge Type: NIHD_Hosp_Profee_Price Antichromatin Abs LC 862355 CDM 305 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price Antichromatin Abs LC 862355 CDM 305 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 LC 862356_300 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Jo-1 LC 862356_300 CDM 300 RC facility both 8.04 8.04 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 862356_305 CDM 305 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-A LC 862356_305 CDM 305 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 862357 CDM 305 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 862357 CDM 305 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price Antichromatin Abs LC 862358_300 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Antichromatin Abs LC 862358_300 CDM 300 RC facility both 7.15 7.15 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 862358_305 CDM 305 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price Smith Abs LC 862358_305 CDM 305 RC facility both 4.64 4.64 Gross Charge Type: NIHD_Hosp_Profee_Price ACCA LC 862551 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price ACCA LC 862551 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price ANA Direct LC 862552 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price ANA Direct LC 862552 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Endomysial Ab IgA LC 862553 CDM 300 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price Endomysial Ab IgA LC 862553 CDM 300 RC facility both 4.54 4.54 Gross Charge Type: NIHD_Hosp_Profee_Price Endomysial Ab IgA LC 862554 CDM 300 RC facility both 4.86 4.86 Gross Charge Type: NIHD_Hosp_Profee_Price Endomysial Ab IgA LC 862554 CDM 300 RC facility both 4.86 4.86 Gross Charge Type: NIHD_Hosp_Profee_Price Endomysial Antibody IgA LC 862555 CDM 300 RC facility both 5.3 5.3 Gross Charge Type: NIHD_Hosp_Profee_Price Endomysial Antibody IgA LC 862555 CDM 300 RC facility both 5.3 5.3 Gross Charge Type: NIHD_Hosp_Profee_Price 86256 Scleroderma Comprehensive Plus Profile (RDL) 520130 86256 CDM 301 RC 86256 HCPCS facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price 86256 Scleroderma Comprehensive Plus Profile (RDL) 520130 86256 CDM 301 RC 86256 HCPCS facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-striation Abs LC 862561 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-striation Abs LC 862561 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Antimyeloperoxidase (MPO) Abs LC 862562 CDM 301 RC facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price Antimyeloperoxidase (MPO) Abs LC 862562 CDM 301 RC facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price Antineutrophil Cytoplasmic Ab LC 862563 CDM 300 RC facility both 7.41 7.41 Gross Charge Type: NIHD_Hosp_Profee_Price Antineutrophil Cytoplasmic Ab LC 862563 CDM 300 RC facility both 7.41 7.41 Gross Charge Type: NIHD_Hosp_Profee_Price Antiproteinase 3 (PR-3) Abs LC 862564 CDM 301 RC facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price Antiproteinase 3 (PR-3) Abs LC 862564 CDM 301 RC facility both 6.73 6.73 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 862565 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Sjogren's Anti-SS-B LC 862565 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price ULTRACLIP DUAL TRIGGER BREAST MARKER 863017D 8630171 CDM facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price ULTRACLIP DUAL TRIGGER BREAST MARKER 863017D 8630171 CDM facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price Cancer Antigen (CA) 125 LC 86304 CDM 300 RC facility both 4.7 4.7 Gross Charge Type: NIHD_Hosp_Profee_Price Cancer Antigen (CA) 125 LC 86304 CDM 300 RC facility both 4.7 4.7 Gross Charge Type: NIHD_Hosp_Profee_Price Mono Screen POCT 863081 CDM facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price Mono Screen POCT 863081 CDM facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price Mononucleosis Screen 863082 CDM 300 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price Mononucleosis Screen 863082 CDM 300 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price PSA Total 86315 CDM 301 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price PSA Total 86315 CDM 301 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price Chromogranin A LC 86316 CDM 300 RC facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price Chromogranin A LC 86316 CDM 300 RC facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price Tetanus/Diphtheria Ab LC 86317 CDM 300 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price Tetanus/Diphtheria Ab LC 86317 CDM 300 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price Hepatitis B Surf Ab Quant LC 863171 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price Hepatitis B Surf Ab Quant LC 863171 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price .Immunofixation Elect LC 863341 CDM 300 RC facility both 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price .Immunofixation Elect LC 863341 CDM 300 RC facility both 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price Albumin: LC 863342 CDM 300 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price Albumin: LC 863342 CDM 300 RC facility both 5.65 5.65 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunofixation Result, Serum: LC" 863343 CDM 300 RC facility both 10.61 10.61 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunofixation Result, Serum: LC" 863343 CDM 300 RC facility both 10.61 10.61 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein, Ttl S LC" 863344 CDM 301 RC facility both 2.11 2.11 Gross Charge Type: NIHD_Hosp_Profee_Price "Protein, Ttl S LC" 863344 CDM 301 RC facility both 2.11 2.11 Gross Charge Type: NIHD_Hosp_Profee_Price "Alpha-1-Globulin, U LC" 863352 CDM 300 RC facility both 5.39 5.39 Gross Charge Type: NIHD_Hosp_Profee_Price "Alpha-1-Globulin, U LC" 863352 CDM 300 RC facility both 5.39 5.39 Gross Charge Type: NIHD_Hosp_Profee_Price "Inhibin A, Ultrasensitive LC" 86336 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Inhibin A, Ultrasensitive LC" 86336 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "Intrinsic Factor Abs, Serum LC" 86340 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Intrinsic Factor Abs, Serum LC" 86340 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price GAD-65 Autoantibody LC 86341 CDM 300 RC facility both 36.65 36.65 Gross Charge Type: NIHD_Hosp_Profee_Price GAD-65 Autoantibody LC 86341 CDM 300 RC facility both 36.65 36.65 Gross Charge Type: NIHD_Hosp_Profee_Price IFE Result LC 86344 CDM 300 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price IFE Result LC 86344 CDM 300 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price REF Kleihauer-Betke 86356 CDM 300 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price REF Kleihauer-Betke 86356 CDM 300 RC facility both 275 275 Gross Charge Type: NIHD_Hosp_Profee_Price CD4/CD8 Ratio Profile LC 86360 CDM 300 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price CD4/CD8 Ratio Profile LC 86360 CDM 300 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price Helper T-Lymph-CD4 LC 86361 CDM 300 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price Helper T-Lymph-CD4 LC 86361 CDM 300 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price TPO Ab LC 86376 CDM 301 RC facility both 5.81 5.81 Gross Charge Type: NIHD_Hosp_Profee_Price TPO Ab LC 86376 CDM 301 RC facility both 5.81 5.81 Gross Charge Type: NIHD_Hosp_Profee_Price .Thyroid Peroxidase (TPO) Ab LC 863761 CDM 300 RC facility both 5.99 5.99 Gross Charge Type: NIHD_Hosp_Profee_Price .Thyroid Peroxidase (TPO) Ab LC 863761 CDM 300 RC facility both 5.99 5.99 Gross Charge Type: NIHD_Hosp_Profee_Price "Complement C3, S LC" 863762 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price "Complement C3, S LC" 863762 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Liver-Kidney Microsomal Ab LC 863763 CDM 300 RC facility both 12.49 12.49 Gross Charge Type: NIHD_Hosp_Profee_Price Liver-Kidney Microsomal Ab LC 863763 CDM 300 RC facility both 12.49 12.49 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Peroxidase (TPO) Ab LC 863764 CDM 300 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroid Peroxidase (TPO) Ab LC 863764 CDM 300 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price Rabies Neut.Abs Titrat.(RFFIT) LC 86382 CDM 300 RC facility both 72.47 72.47 Gross Charge Type: NIHD_Hosp_Profee_Price Rabies Neut.Abs Titrat.(RFFIT) LC 86382 CDM 300 RC facility both 72.47 72.47 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Paternity Testing 86387 CDM 999 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price Bill Only Paternity Testing 86387 CDM 999 RC facility both 98 98 Gross Charge Type: NIHD_Hosp_Profee_Price Rheumatoid Factor Qual 86430 CDM 300 RC facility both 130 130 Gross Charge Type: NIHD_Hosp_Profee_Price Rheumatoid Factor Qual 86430 CDM 300 RC facility both 130 130 Gross Charge Type: NIHD_Hosp_Profee_Price 86431 RheumAssure® LC 504509 86431_301 CDM 301 RC 86431 HCPCS facility both 14.37 14.37 Gross Charge Type: NIHD_Hosp_Profee_Price 86431 RheumAssure® LC 504509 86431_301 CDM 301 RC 86431 HCPCS facility both 14.37 14.37 Gross Charge Type: NIHD_Hosp_Profee_Price RA Latex Turbid. LC 86431_305 CDM 305 RC facility both 4.63 4.63 Gross Charge Type: NIHD_Hosp_Profee_Price RA Latex Turbid. LC 86431_305 CDM 305 RC facility both 4.63 4.63 Gross Charge Type: NIHD_Hosp_Profee_Price Complement C4 LC 864311 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Complement C4 LC 864311 CDM 300 RC facility both 5.33 5.33 Gross Charge Type: NIHD_Hosp_Profee_Price Rheumatoid Arthritis Factor LC 864312 CDM 300 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price Rheumatoid Arthritis Factor LC 864312 CDM 300 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price QuantiFERON-TB Plus(Client Incubated) LC 86480 CDM 300 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price QuantiFERON-TB Plus(Client Incubated) LC 86480 CDM 300 RC facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price "Skin test; tuberculosis, intradermal" 865801 CDM 300 RC 86580 HCPCS facility both 28 28 Gross Charge Type: NIHD_RHC_Price "Skin test; tuberculosis, intradermal" 865801 CDM 300 RC 86580 HCPCS facility both 28 28 Gross Charge Type: NIHD_Clinic_Price "Skin test; tuberculosis, intradermal" 865801 CDM 300 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price "Skin test; tuberculosis, intradermal" 865801 CDM 300 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price PPD Reading POC 865802 CDM 86580 HCPCS facility both 34 34 Gross Charge Type: NIHD_RHC_Price PPD Reading POC 865802 CDM 86580 HCPCS facility both 24 24 Gross Charge Type: NIHD_Clinic_Price PPD Reading POC 865803 CDM 300 RC 86580 HCPCS facility both 34 34 Gross Charge Type: NIHD_RHC_Price PPD Reading POC 865803 CDM 300 RC 86580 HCPCS facility both 34 34 Gross Charge Type: NIHD_Clinic_Price PPD Administration (TB Screen) POC 865804 CDM 300 RC 86580 HCPCS facility both 34 34 Gross Charge Type: NIHD_RHC_Price PPD Administration (TB Screen) POC 865804 CDM 300 RC 86580 HCPCS facility both 34 34 Gross Charge Type: NIHD_Clinic_Price PPD Reading (TB) POC 865805 CDM 300 RC 86580 HCPCS facility both 34 34 Gross Charge Type: NIHD_RHC_Price PPD Reading (TB) POC 865805 CDM 300 RC 86580 HCPCS facility both 34 34 Gross Charge Type: NIHD_Clinic_Price "RPR, Rfx Qn RPR/Confirm TP LC" 86592_301 CDM 301 RC facility both 1.63 1.63 Gross Charge Type: NIHD_Hosp_Profee_Price "RPR, Rfx Qn RPR/Confirm TP LC" 86592_301 CDM 301 RC facility both 1.63 1.63 Gross Charge Type: NIHD_Hosp_Profee_Price "VDRL, CSF LC" 86592_302 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price "VDRL, CSF LC" 86592_302 CDM 302 RC facility both 3.26 3.26 Gross Charge Type: NIHD_Hosp_Profee_Price RPR LC 865921 CDM 302 RC facility both 1.63 1.63 Gross Charge Type: NIHD_Hosp_Profee_Price RPR LC 865921 CDM 302 RC facility both 1.63 1.63 Gross Charge Type: NIHD_Hosp_Profee_Price .RPR LC 865922 CDM 302 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price .RPR LC 865922 CDM 302 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price .RPR Qn LC 865931 CDM 300 RC facility both 5.38 5.38 Gross Charge Type: NIHD_Hosp_Profee_Price .RPR Qn LC 865931 CDM 300 RC facility both 5.38 5.38 Gross Charge Type: NIHD_Hosp_Profee_Price "Rapid Plasma Reagin, Quant LC" 865932 CDM 300 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price "Rapid Plasma Reagin, Quant LC" 865932 CDM 300 RC facility both 3 3 Gross Charge Type: NIHD_Hosp_Profee_Price ".RPR, Quant LC" 865933 CDM 300 RC facility both 5.38 5.38 Gross Charge Type: NIHD_Hosp_Profee_Price ".RPR, Quant LC" 865933 CDM 300 RC facility both 5.38 5.38 Gross Charge Type: NIHD_Hosp_Profee_Price "RPR, Quant. LC" 865934 CDM 300 RC facility both 2.45 2.45 Gross Charge Type: NIHD_Hosp_Profee_Price "RPR, Quant. LC" 865934 CDM 300 RC facility both 2.45 2.45 Gross Charge Type: NIHD_Hosp_Profee_Price B pertussis IgG/IgM Ab LC 86615 CDM 300 RC facility both 31.48 31.48 Gross Charge Type: NIHD_Hosp_Profee_Price B pertussis IgG/IgM Ab LC 86615 CDM 300 RC facility both 31.48 31.48 Gross Charge Type: NIHD_Hosp_Profee_Price B pertussis IgG Ab LC 866151 CDM 300 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price B pertussis IgG Ab LC 866151 CDM 300 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price "Lyme, Western Blot, Serum LC" 86617 CDM 300 RC facility both 15.8 15.8 Gross Charge Type: NIHD_Hosp_Profee_Price "Lyme, Western Blot, Serum LC" 86617 CDM 300 RC facility both 15.8 15.8 Gross Charge Type: NIHD_Hosp_Profee_Price .Lyme Western Blot LC 866171 CDM 300 RC facility both 15.8 15.8 Gross Charge Type: NIHD_Hosp_Profee_Price .Lyme Western Blot LC 866171 CDM 300 RC facility both 15.8 15.8 Gross Charge Type: NIHD_Hosp_Profee_Price Lyme Disease Serology w/Reflex LC 86618 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price Lyme Disease Serology w/Reflex LC 86618 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price Lyme Ab/Western Blot Reflex LC 866181 CDM 300 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price Lyme Ab/Western Blot Reflex LC 866181 CDM 300 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price Coccidioides Antibody by CF LC 86635 CDM 300 RC facility both 42.8 42.8 Gross Charge Type: NIHD_Hosp_Profee_Price Coccidioides Antibody by CF LC 86635 CDM 300 RC facility both 42.8 42.8 Gross Charge Type: NIHD_Hosp_Profee_Price "Cytomegalovirus (CMV) Ab, IgM LC" 86645 CDM 300 RC facility both 4.28 4.28 Gross Charge Type: NIHD_Hosp_Profee_Price "Cytomegalovirus (CMV) Ab, IgM LC" 86645 CDM 300 RC facility both 4.28 4.28 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Early Antigen Ab, IgG LC" 86663 CDM 300 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Early Antigen Ab, IgG LC" 86663 CDM 300 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Nuclear Ag Ab, IgG LC" 86664 CDM 300 RC facility both 8.12 8.12 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Nuclear Ag Ab, IgG LC" 86664 CDM 300 RC facility both 8.12 8.12 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Ab VCA, IgG LC" 866651 CDM 300 RC facility both 20.37 20.37 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Ab VCA, IgG LC" 866651 CDM 300 RC facility both 20.37 20.37 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Ab VCA, IgM LC" 866652 CDM 300 RC facility both 11 11 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Ab VCA, IgM LC" 866652 CDM 300 RC facility both 11 11 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Ab VCA, IgM LC" 866653 CDM 300 RC facility both 12.19 12.19 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Ab VCA, IgM LC" 866653 CDM 300 RC facility both 12.19 12.19 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Ab VCA, IgG LC" 866654 CDM 300 RC facility both 12.18 12.18 Gross Charge Type: NIHD_Hosp_Profee_Price "EBV Ab VCA, IgG LC" 866654 CDM 300 RC facility both 12.18 12.18 Gross Charge Type: NIHD_Hosp_Profee_Price ALCA LC 86671 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price ALCA LC 86671 CDM 301 RC facility both 15.9 15.9 Gross Charge Type: NIHD_Hosp_Profee_Price H. Pylori Antibody IgG 86677 CDM 302 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price H. Pylori Antibody IgG 86677 CDM 302 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price H. Pylori Antibody 8667712 CDM 302 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price H. Pylori Antibody 8667712 CDM 302 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price "H. pylori, IgM Ab LC" 866772 CDM 302 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price "H. pylori, IgM Ab LC" 866772 CDM 302 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price Strongyloides IgG Antibody LC 86682 CDM 302 RC facility both 39.25 39.25 Gross Charge Type: NIHD_Hosp_Profee_Price Strongyloides IgG Antibody LC 86682 CDM 302 RC facility both 39.25 39.25 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV, IgM I/II Combination LC" 86694 CDM 300 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV, IgM I/II Combination LC" 86694 CDM 300 RC facility both 5.7 5.7 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV 2 IgG, Type Spec LC" 866954 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV 2 IgG, Type Spec LC" 866954 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price HSV 2 IgM Abs LC 866955 CDM 300 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price HSV 2 IgM Abs LC 866955 CDM 300 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price .HSV-2 IgG Supplemental LC 866961 CDM 300 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price .HSV-2 IgG Supplemental LC 866961 CDM 300 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV 1 IgG, Type Spec LC" 866962 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV 1 IgG, Type Spec LC" 866962 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price HSV 1 IgM Abs LC 866963 CDM 300 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price HSV 1 IgM Abs LC 866963 CDM 300 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV-2 Type Spec Ab, IgG w/Rflx LC" 866964 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "HSV-2 Type Spec Ab, IgG w/Rflx LC" 866964 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price HSV-2 Ab IgG LC 866965 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price HSV-2 Ab IgG LC 866965 CDM 301 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgM LC 86697 CDM 305 RC facility both 30.78 30.78 Gross Charge Type: NIHD_Hosp_Profee_Price B2 glycoprot I IgM LC 86697 CDM 305 RC facility both 30.78 30.78 Gross Charge Type: NIHD_Hosp_Profee_Price HIV-2 Ab LC 86701 CDM 300 RC facility both 27.5 27.5 Gross Charge Type: NIHD_Hosp_Profee_Price HIV-2 Ab LC 86701 CDM 300 RC facility both 27.5 27.5 Gross Charge Type: NIHD_Hosp_Profee_Price HIV-1 Ab LC 86702 CDM 300 RC facility both 27.5 27.5 Gross Charge Type: NIHD_Hosp_Profee_Price HIV-1 Ab LC 86702 CDM 300 RC facility both 27.5 27.5 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Ab LC 867041 CDM 300 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Ab LC 867041 CDM 300 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, Tot LC" 867042 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, Tot LC" 867042 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, Tot LC" 867043 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, Tot LC" 867043 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, IgM LC" 867051 CDM 300 RC facility both 3.5 3.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, IgM LC" 867051 CDM 300 RC facility both 3.5 3.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, IgM LC" 867052 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, IgM LC" 867052 CDM 300 RC facility both 2.82 2.82 Gross Charge Type: NIHD_Hosp_Profee_Price Hepatitis B Surf Ab Ql LC 867053 CDM 300 RC facility both 3.05 3.05 Gross Charge Type: NIHD_Hosp_Profee_Price Hepatitis B Surf Ab Ql LC 867053 CDM 300 RC facility both 3.05 3.05 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Surface Ab, Qual. LC" 867061 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Surface Ab, Qual. LC" 867061 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price Hep Be Ag LC 867062 CDM 300 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price Hep Be Ag LC 867062 CDM 300 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price Hep Be Ab LC 86707 CDM 300 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price Hep Be Ab LC 86707 CDM 300 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep A Ab, Total LC" 86708 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep A Ab, Total LC" 86708 CDM 300 RC facility both 5 5 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep A Ab, IgM LC" 86709 CDM 300 RC facility both 4.7 4.7 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep A Ab, IgM LC" 86709 CDM 300 RC facility both 4.7 4.7 Gross Charge Type: NIHD_Hosp_Profee_Price "Mumps Antibodies, IgG LC" 867351 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price "Mumps Antibodies, IgG LC" 867351 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price "Mumps Antibodies, IgM LC" 867352 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "Mumps Antibodies, IgM LC" 867352 CDM 300 RC facility both 10 10 Gross Charge Type: NIHD_Hosp_Profee_Price "Rubeola Ab, IgG LC" 867353 CDM 300 RC facility both 2.57 2.57 Gross Charge Type: NIHD_Hosp_Profee_Price "Rubeola Ab, IgG LC" 867353 CDM 300 RC facility both 2.57 2.57 Gross Charge Type: NIHD_Hosp_Profee_Price Mycoplasma pneu. IgG/IgM Abs LC 86738 CDM 300 RC facility both 11.4 11.4 Gross Charge Type: NIHD_Hosp_Profee_Price Mycoplasma pneu. IgG/IgM Abs LC 86738 CDM 300 RC facility both 11.4 11.4 Gross Charge Type: NIHD_Hosp_Profee_Price "Mumps Abs, IgG LC" 867621 CDM 300 RC facility both 2.58 2.58 Gross Charge Type: NIHD_Hosp_Profee_Price "Mumps Abs, IgG LC" 867621 CDM 300 RC facility both 2.58 2.58 Gross Charge Type: NIHD_Hosp_Profee_Price "Rubella Antibodies, IgG LC" 867622 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price "Rubella Antibodies, IgG LC" 867622 CDM 300 RC facility both 2.44 2.44 Gross Charge Type: NIHD_Hosp_Profee_Price "Rubella Antibodies, IgG LC" 867651 CDM 300 RC facility both 2.58 2.58 Gross Charge Type: NIHD_Hosp_Profee_Price "Rubella Antibodies, IgG LC" 867651 CDM 300 RC facility both 2.58 2.58 Gross Charge Type: NIHD_Hosp_Profee_Price "Rubeola Antibodies, IgG LC" 867652 CDM 300 RC facility both 2.85 2.85 Gross Charge Type: NIHD_Hosp_Profee_Price "Rubeola Antibodies, IgG LC" 867652 CDM 300 RC facility both 2.85 2.85 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 Semi-Quant Spike Ab LC 86769_1 CDM 300 RC facility both 42.13 42.13 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 Semi-Quant Spike Ab LC 86769_1 CDM 300 RC facility both 42.13 42.13 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19) IgG Antibody 86769_2 CDM 300 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19) IgG Antibody 86769_2 CDM 300 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price "Toxoplasma gondii Ab, IgG, Qn LC" 86777 CDM 300 RC facility both 5.29 5.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Toxoplasma gondii Ab, IgG, Qn LC" 86777 CDM 300 RC facility both 5.29 5.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Toxoplasma gondii Ab,IgM LC" 86778 CDM 300 RC facility both 7.33 7.33 Gross Charge Type: NIHD_Hosp_Profee_Price "Toxoplasma gondii Ab,IgM LC" 86778 CDM 300 RC facility both 7.33 7.33 Gross Charge Type: NIHD_Hosp_Profee_Price T pallidum Screening Cascade LC 867802 CDM 300 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price T pallidum Screening Cascade LC 867802 CDM 300 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price "West Nile Virus, IgM LC" 86788 CDM 300 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "West Nile Virus, IgM LC" 86788 CDM 300 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "West Nile Virus, IgG LC" 86789 CDM 300 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "West Nile Virus, IgG LC" 86789 CDM 300 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroglob Ab LC 86800 CDM 301 RC facility both 5.82 5.82 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroglob Ab LC 86800 CDM 301 RC facility both 5.82 5.82 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Thyroglobulin Abs LC 868001 CDM 300 RC facility both 23.23 23.23 Gross Charge Type: NIHD_Hosp_Profee_Price Anti-Thyroglobulin Abs LC 868001 CDM 300 RC facility both 23.23 23.23 Gross Charge Type: NIHD_Hosp_Profee_Price "TgAb+Thyroglobulin,IMA or LCMS LC" 868002 CDM 300 RC facility both 6.74 6.74 Gross Charge Type: NIHD_Hosp_Profee_Price "TgAb+Thyroglobulin,IMA or LCMS LC" 868002 CDM 300 RC facility both 6.74 6.74 Gross Charge Type: NIHD_Hosp_Profee_Price "TgAb+Thyroglobulin,IMA or RIA LC" 868003 CDM 300 RC facility both 6.74 6.74 Gross Charge Type: NIHD_Hosp_Profee_Price "TgAb+Thyroglobulin,IMA or RIA LC" 868003 CDM 300 RC facility both 6.74 6.74 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroglobulin Antibody LC 868004 CDM 300 RC facility both 6.74 6.74 Gross Charge Type: NIHD_Hosp_Profee_Price Thyroglobulin Antibody LC 868004 CDM 300 RC facility both 6.74 6.74 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Ab w/Rflx to Verification LC 868031 CDM 300 RC facility both 5.19 5.19 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Ab w/Rflx to Verification LC 868031 CDM 300 RC facility both 5.19 5.19 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Antibody LC 868032 CDM 300 RC facility both 5.19 5.19 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Antibody LC 868032 CDM 300 RC facility both 5.19 5.19 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Antibody reflex to NAA LC 868033 CDM 300 RC facility both 5.19 5.19 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Antibody reflex to NAA LC 868033 CDM 300 RC facility both 5.19 5.19 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, IgM LC" 868034 CDM 300 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, IgM LC" 868034 CDM 300 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price .HCV Ab Verification LC 86804 CDM 300 RC facility both 386 386 Gross Charge Type: NIHD_Hosp_Profee_Price .HCV Ab Verification LC 86804 CDM 300 RC facility both 386 386 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Ratio LC 86849 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price dRVVT Ratio LC 86849 CDM 305 RC facility both 61.62 61.62 Gross Charge Type: NIHD_Hosp_Profee_Price Antibody Screen Gel 86850 CDM 302 RC facility both 221 221 Gross Charge Type: NIHD_Hosp_Profee_Price Antibody Screen Gel 86850 CDM 302 RC facility both 221 221 Gross Charge Type: NIHD_Hosp_Profee_Price REF Antibody Screen 868501 CDM 300 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price REF Antibody Screen 868501 CDM 300 RC facility both 90 90 Gross Charge Type: NIHD_Hosp_Profee_Price Syphilis T. Pallidum Ab IgG/IgM 868502 CDM 86780 HCPCS facility both 102 102 Gross Charge Type: NIHD_Clinic_Price Syphilis T. Pallidum Ab IgG/IgM 868502 CDM 300 RC facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price Syphilis T. Pallidum Ab IgG/IgM 868502 CDM 300 RC facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price REF Cord Blood Elution 868601 CDM 300 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price REF Cord Blood Elution 868601 CDM 300 RC facility both 87 87 Gross Charge Type: NIHD_Hosp_Profee_Price REF Elution 868602 CDM 300 RC facility both 91 91 Gross Charge Type: NIHD_Hosp_Profee_Price REF Elution 868602 CDM 300 RC facility both 91 91 Gross Charge Type: NIHD_Hosp_Profee_Price REF Antibody ID 86870 CDM 300 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price REF Antibody ID 86870 CDM 300 RC facility both 132 132 Gross Charge Type: NIHD_Hosp_Profee_Price REF DAT Poly 86880_300 CDM 300 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price REF DAT Poly 86880_300 CDM 300 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price DAT Poly 5' Tube 86880_390 CDM 390 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price DAT Poly 5' Tube 86880_390 CDM 390 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price Cord DAT 868801_300 CDM 300 RC facility both 123.6 123.6 Gross Charge Type: NIHD_Hosp_Profee_Price Cord DAT 868801_300 CDM 300 RC facility both 123.6 123.6 Gross Charge Type: NIHD_Hosp_Profee_Price DAT Poly Tube 868801_390 CDM 390 RC facility both 24.3 24.3 Gross Charge Type: NIHD_Hosp_Profee_Price DAT Poly Tube 868801_390 CDM 390 RC facility both 24.3 24.3 Gross Charge Type: NIHD_Hosp_Profee_Price DAT IgG Gel. 868803 CDM 300 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price DAT IgG Gel. 868803 CDM 300 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price DAT IgG/C3 868804 CDM 300 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price DAT IgG/C3 868804 CDM 300 RC facility both 193 193 Gross Charge Type: NIHD_Hosp_Profee_Price .Post TR DAT Poly 5' Tube 868805 CDM 390 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price .Post TR DAT Poly 5' Tube 868805 CDM 390 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price .Pre TR DAT Poly 5' Tube 868806 CDM 390 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price .Pre TR DAT Poly 5' Tube 868806 CDM 390 RC facility both 24 24 Gross Charge Type: NIHD_Hosp_Profee_Price .Post TR ABO/Rh 86900 CDM 390 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price .Post TR ABO/Rh 86900 CDM 390 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price Cord ABO/Rh Gel 869001_300 CDM 300 RC facility both 72.8 72.8 Gross Charge Type: NIHD_Hosp_Profee_Price Cord ABO/Rh Gel 869001_300 CDM 300 RC facility both 72.8 72.8 Gross Charge Type: NIHD_Hosp_Profee_Price .Pre TR ABO/Rh 869001_390 CDM 390 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price .Pre TR ABO/Rh 869001_390 CDM 390 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price Cord ABO/Rh 3 869002 CDM 300 RC facility both 72.8 72.8 Gross Charge Type: NIHD_Hosp_Profee_Price Cord ABO/Rh 3 869002 CDM 300 RC facility both 72.8 72.8 Gross Charge Type: NIHD_Hosp_Profee_Price REF ABO 869003 CDM 300 RC facility both 33 33 Gross Charge Type: NIHD_Hosp_Profee_Price REF ABO 869003 CDM 300 RC facility both 33 33 Gross Charge Type: NIHD_Hosp_Profee_Price Newborn ABO/Rh 869005 CDM 390 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price Newborn ABO/Rh 869005 CDM 390 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price REF Rh 869012 CDM 300 RC facility both 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price REF Rh 869012 CDM 300 RC facility both 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price Rh Only 869013 CDM 300 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price Rh Only 869013 CDM 300 RC facility both 99 99 Gross Charge Type: NIHD_Hosp_Profee_Price REF Antigen Type 86905 CDM 300 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price REF Antigen Type 86905 CDM 300 RC facility both 80 80 Gross Charge Type: NIHD_Hosp_Profee_Price REF Rh Phenotyping 86906 CDM 300 RC facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price REF Rh Phenotyping 86906 CDM 300 RC facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price Computer Crossmatch Interp -> Computer XM OK 869201 CDM 302 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price Computer Crossmatch Interp -> Computer XM OK 869201 CDM 302 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price Serological Immediate Spin -> Compatible 869202 CDM 302 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price Serological Immediate Spin -> Compatible 869202 CDM 302 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price Serological Immediate Spin -> Corrected 869203 CDM 302 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price Serological Immediate Spin -> Corrected 869203 CDM 302 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price Serological Immediate Spin -> Incompatible 869204 CDM 302 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price Serological Immediate Spin -> Incompatible 869204 CDM 302 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price XM AHG Gel Interp -> Compatible 86922 CDM 300 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price XM AHG Gel Interp -> Compatible 86922 CDM 300 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price E7646 Aph Plasma ACDA 86927 CDM 309 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price E7644 Aph Plasma RT<=24 Frz<=24 86927_E7644 CDM 309 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price E7650 Aph Plasma ACDA RT<=24 Frz<=24 3 86927_E7650 CDM 309 RC facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price E7650 Aph Plasma ACDA RT<=24 Frz<=24 3 86927_E7650 CDM 309 RC facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price REF Enzyme Treat 86971 CDM 300 RC facility both 150 150 Gross Charge Type: NIHD_Hosp_Profee_Price REF Enzyme Treat 86971 CDM 300 RC facility both 150 150 Gross Charge Type: NIHD_Hosp_Profee_Price REF Alloadsorption 86978 CDM 300 RC facility both 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price REF Alloadsorption 86978 CDM 300 RC facility both 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Repair Ptosis 8700754 CDM 360 RC facility both 3537 3537 Gross Charge Type: NIHD_Hosp_Profee_Price Repair Ptosis 8700754 CDM 360 RC facility both 3537 3537 Gross Charge Type: NIHD_Hosp_Profee_Price Osteocalcin LC 8702565 CDM 300 RC facility both 20.36 20.36 Gross Charge Type: NIHD_Hosp_Profee_Price Osteocalcin LC 8702565 CDM 300 RC facility both 20.36 20.36 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Culture 87040 CDM 306 RC facility both 590 590 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Culture 87040 CDM 306 RC facility both 590 590 Gross Charge Type: NIHD_Hosp_Profee_Price "Blood Culture, Routine LC" 870401 CDM 306 RC facility both 491 491 Gross Charge Type: NIHD_Hosp_Profee_Price "Blood Culture, Routine LC" 870401 CDM 306 RC facility both 491 491 Gross Charge Type: NIHD_Hosp_Profee_Price Stool Culture 87045 CDM 306 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price Stool Culture 87045 CDM 306 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price Charge for Presumptive Stool ID 87046 CDM 306 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price Charge for Presumptive Stool ID 87046 CDM 306 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price .Sputum Culture LC 870701 CDM 306 RC facility both 12.1 12.1 Gross Charge Type: NIHD_Hosp_Profee_Price .Sputum Culture LC 870701 CDM 306 RC facility both 12.1 12.1 Gross Charge Type: NIHD_Hosp_Profee_Price Throat Culture 8707010 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Throat Culture 8707010 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Tissue Culture 8707011 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Tissue Culture 8707011 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Wound Culture 8707012 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Wound Culture 8707012 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Upper Respiratory Culture LC 870702 CDM 306 RC facility both 4.95 4.95 Gross Charge Type: NIHD_Hosp_Profee_Price Upper Respiratory Culture LC 870702 CDM 306 RC facility both 4.95 4.95 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Unit Culture 870703 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Blood Unit Culture 870703 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Aerobic Bacterial Culture LC 8707031 CDM 306 RC facility both 8.14 8.14 Gross Charge Type: NIHD_Hosp_Profee_Price Aerobic Bacterial Culture LC 8707031 CDM 306 RC facility both 8.14 8.14 Gross Charge Type: NIHD_Hosp_Profee_Price Cerebrospinal Fluid Culture 8707032 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Cerebrospinal Fluid Culture 8707032 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Wound Culture Deep 870704 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Wound Culture Deep 870704 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Body Fluid Culture 8707041 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Body Fluid Culture 8707041 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Ear Culture 8707042 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Ear Culture 8707042 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Eye Culture 870705 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Eye Culture 870705 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Genital Culture 870706 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Genital Culture 870706 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Nasal Culture 870707 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Nasal Culture 870707 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Respiratory Culture 870708 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Respiratory Culture 870708 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Sputum Culture 870709 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Sputum Culture 870709 CDM 306 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Anaerobic Culture 870752 CDM 306 RC facility both 520 520 Gross Charge Type: NIHD_Hosp_Profee_Price Anaerobic Culture 870752 CDM 306 RC facility both 520 520 Gross Charge Type: NIHD_Hosp_Profee_Price .Anaerobic ID by MALDI LC 87076 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Anaerobic ID by MALDI LC 87076 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price Anaerobe Identification Only LC 870761 CDM 306 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price Anaerobe Identification Only LC 870761 CDM 306 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price Aerobe ID + Suscept LC 87077 CDM 306 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price Aerobe ID + Suscept LC 87077 CDM 306 RC facility both 12.22 12.22 Gross Charge Type: NIHD_Hosp_Profee_Price .Aerobic ID by MALDI LC 870771 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Aerobic ID by MALDI LC 870771 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price Organism ID by MALDI LC 870772 CDM 306 RC facility both 9.29 9.29 Gross Charge Type: NIHD_Hosp_Profee_Price Organism ID by MALDI LC 870772 CDM 306 RC facility both 9.29 9.29 Gross Charge Type: NIHD_Hosp_Profee_Price Gram negative identification (Vitek) 8707721 CDM 306 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price Gram negative identification (Vitek) 8707721 CDM 306 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price Gram positive identification (Vitek) 8707722 CDM 306 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price Gram positive identification (Vitek) 8707722 CDM 306 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price MRSA Screening Culture LC 870811 CDM 306 RC facility both 150 150 Gross Charge Type: NIHD_Hosp_Profee_Price MRSA Screening Culture LC 870811 CDM 306 RC facility both 150 150 Gross Charge Type: NIHD_Hosp_Profee_Price Beta Strep Throat Culture 870812 CDM 306 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Beta Strep Throat Culture 870812 CDM 306 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Gardnerella Vaginalis Culture 870813 CDM 306 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price Gardnerella Vaginalis Culture 870813 CDM 306 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price Neisseria gonorrhea Culture 870814 CDM 306 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price Neisseria gonorrhea Culture 870814 CDM 306 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price Group B Strep Culture 870815 CDM 306 RC facility both 156 156 Gross Charge Type: NIHD_Hosp_Profee_Price Group B Strep Culture 870815 CDM 306 RC facility both 156 156 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Culture 87086 CDM 306 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Urine Culture 87086 CDM 306 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Digoxin LC 87087 CDM 301 RC facility both 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price Digoxin LC 87087 CDM 301 RC facility both 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price Charge for Presumptive Urine ID 87088 CDM 306 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price Charge for Presumptive Urine ID 87088 CDM 306 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price Fungus (Mycology) Culture LC 871011 CDM 306 RC facility both 9.39 9.39 Gross Charge Type: NIHD_Hosp_Profee_Price Fungus (Mycology) Culture LC 871011 CDM 306 RC facility both 9.39 9.39 Gross Charge Type: NIHD_Hosp_Profee_Price Fungus Stain Status LC 871012 CDM 306 RC facility both 7.5 7.5 Gross Charge Type: NIHD_Hosp_Profee_Price Fungus Stain Status LC 871012 CDM 306 RC facility both 7.5 7.5 Gross Charge Type: NIHD_Hosp_Profee_Price Yeast Culture 87102 CDM 306 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price Yeast Culture 87102 CDM 306 RC facility both 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price .Yeast ID by MALDI LC 87106 CDM 306 RC facility both 38.59 38.59 Gross Charge Type: NIHD_Hosp_Profee_Price .Yeast ID by MALDI LC 87106 CDM 306 RC facility both 38.59 38.59 Gross Charge Type: NIHD_Hosp_Profee_Price .Mold ID 080225 LC 87107 CDM 306 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price .Mold ID 080225 LC 87107 CDM 306 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price Ureaplasma/Mycoplasma hominis LC 87109 CDM 306 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price Ureaplasma/Mycoplasma hominis LC 87109 CDM 306 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price AFB Specimen Processing LC 871161 CDM 306 RC facility both 7 7 Gross Charge Type: NIHD_Hosp_Profee_Price AFB Specimen Processing LC 871161 CDM 306 RC facility both 7 7 Gross Charge Type: NIHD_Hosp_Profee_Price Acid Fast Smear LC 871162 CDM 306 RC facility both 8.64 8.64 Gross Charge Type: NIHD_Hosp_Profee_Price Acid Fast Smear LC 871162 CDM 306 RC facility both 8.64 8.64 Gross Charge Type: NIHD_Hosp_Profee_Price Circumcision (Pediatric) 8713434 CDM 360 RC facility both 4038 4038 Gross Charge Type: NIHD_Hosp_Profee_Price Circumcision (Pediatric) 8713434 CDM 360 RC facility both 4038 4038 Gross Charge Type: NIHD_Hosp_Profee_Price "Strep A,B,C,D,F,G Latex" 87147 CDM 306 RC facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price "Strep A,B,C,D,F,G Latex" 87147 CDM 306 RC facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price .AFB ID by DNA Probe Rflx AST LC 87149 CDM 306 RC facility both 109.75 109.75 Gross Charge Type: NIHD_Hosp_Profee_Price .AFB ID by DNA Probe Rflx AST LC 87149 CDM 306 RC facility both 109.75 109.75 Gross Charge Type: NIHD_Hosp_Profee_Price .AFB ID by DNA Probe LC 871491 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price .AFB ID by DNA Probe LC 871491 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price Organism ID by Sequencing LC 87153 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price Organism ID by Sequencing LC 87153 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Aerobic Bact ID by Seq LC 871531 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Aerobic Bact ID by Seq LC 871531 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Anaerobic Bact ID by Seq LC 871532 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Anaerobic Bact ID by Seq LC 871532 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Mold ID by Seq LC 871533 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Mold ID by Seq LC 871533 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Mycobact ID by Seq LC 871534 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Mycobact ID by Seq LC 871534 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Nocardia ID by Seq LC 871535 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Nocardia ID by Seq LC 871535 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Org ID by Sequencing Rflx AST LC 871537 CDM 306 RC facility both 26 26 Gross Charge Type: NIHD_Hosp_Profee_Price .Org ID by Sequencing Rflx AST LC 871537 CDM 306 RC facility both 26 26 Gross Charge Type: NIHD_Hosp_Profee_Price .Yeast ID by Seq LC 871538 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price .Yeast ID by Seq LC 871538 CDM 306 RC facility both 65 65 Gross Charge Type: NIHD_Hosp_Profee_Price Charge for Tissue Grinding 87176 CDM 306 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Charge for Tissue Grinding 87176 CDM 306 RC facility both 73 73 Gross Charge Type: NIHD_Hosp_Profee_Price Ova + Parasite Status LC 87177 CDM 300 RC facility both 4.37 4.37 Gross Charge Type: NIHD_Hosp_Profee_Price Ova + Parasite Status LC 87177 CDM 300 RC facility both 4.37 4.37 Gross Charge Type: NIHD_Hosp_Profee_Price "Susceptibility, Anaerobic, MIC LC" 87181 CDM 306 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price "Susceptibility, Anaerobic, MIC LC" 87181 CDM 306 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price Strep Gp B Susceptibility LC 871841 CDM 306 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price Strep Gp B Susceptibility LC 871841 CDM 306 RC facility both 39 39 Gross Charge Type: NIHD_Hosp_Profee_Price Kirby-Bauer 871842 CDM 306 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price Kirby-Bauer 871842 CDM 306 RC facility both 103 103 Gross Charge Type: NIHD_Hosp_Profee_Price Beta Lactamase 87185 CDM 306 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Beta Lactamase 87185 CDM 306 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Anaerobic and Aerobic Culture LC 87186 CDM 306 RC facility both 9.5 9.5 Gross Charge Type: NIHD_Hosp_Profee_Price Anaerobic and Aerobic Culture LC 87186 CDM 306 RC facility both 9.5 9.5 Gross Charge Type: NIHD_Hosp_Profee_Price .M. marinum Susceptibility LC 8718611 CDM 306 RC facility both 121 121 Gross Charge Type: NIHD_Hosp_Profee_Price .M. marinum Susceptibility LC 8718611 CDM 306 RC facility both 121 121 Gross Charge Type: NIHD_Hosp_Profee_Price "Minimum Inhibitory Concentration (MIC), One Drug LC" 8718612_300 CDM 300 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Minimum Inhibitory Concentration (MIC), One Drug LC" 8718612_300 CDM 300 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Susceptibility, Aer + Anaerob LC" 8718612_306 CDM 306 RC facility both 9.5 9.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Susceptibility, Aer + Anaerob LC" 8718612_306 CDM 306 RC facility both 9.5 9.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Slow Grower Broth Suscep LC 8718621 CDM 306 RC facility both 121 121 Gross Charge Type: NIHD_Hosp_Profee_Price .Slow Grower Broth Suscep LC 8718621 CDM 306 RC facility both 121 121 Gross Charge Type: NIHD_Hosp_Profee_Price Minimum Inhibitory Concentration 8718622 CDM 306 RC facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price Minimum Inhibitory Concentration 8718622 CDM 306 RC facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price .Rapid Grower Broth Suscep LC 871863 CDM 306 RC facility both 121 121 Gross Charge Type: NIHD_Hosp_Profee_Price .Rapid Grower Broth Suscep LC 871863 CDM 306 RC facility both 121 121 Gross Charge Type: NIHD_Hosp_Profee_Price .Nocardia Susceptibility Broth LC 871864 CDM 306 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price .Nocardia Susceptibility Broth LC 871864 CDM 306 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price .MAC Susceptibility Broth LC 871865 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price .MAC Susceptibility Broth LC 871865 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price "Susceptibility, Gram Pos Rods LC" 871867 CDM 300 RC facility both 26 26 Gross Charge Type: NIHD_Hosp_Profee_Price "Susceptibility, Gram Pos Rods LC" 871867 CDM 300 RC facility both 26 26 Gross Charge Type: NIHD_Hosp_Profee_Price "Eosinophil, Urine LC" 8720511 CDM 306 RC facility both 72 72 Gross Charge Type: NIHD_Hosp_Profee_Price "Eosinophil, Urine LC" 8720511 CDM 306 RC facility both 72 72 Gross Charge Type: NIHD_Hosp_Profee_Price Gram Stain w/Sputum Cult Rflx LC 8720512 CDM 306 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price Gram Stain w/Sputum Cult Rflx LC 8720512 CDM 306 RC facility both 24.44 24.44 Gross Charge Type: NIHD_Hosp_Profee_Price Gram Stain Report 872052 CDM 306 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Gram Stain Report 872052 CDM 306 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Acid Fast Culture LC 872061 CDM 306 RC facility both 8.63 8.63 Gross Charge Type: NIHD_Hosp_Profee_Price Acid Fast Culture LC 872061 CDM 306 RC facility both 8.63 8.63 Gross Charge Type: NIHD_Hosp_Profee_Price Acid Fast Smear LC 872062 CDM 306 RC facility both 7 7 Gross Charge Type: NIHD_Hosp_Profee_Price Acid Fast Smear LC 872062 CDM 306 RC facility both 7 7 Gross Charge Type: NIHD_Hosp_Profee_Price Fungus (Mycology) Culture LC 872063 CDM 306 RC facility both 7.5 7.5 Gross Charge Type: NIHD_Hosp_Profee_Price Fungus (Mycology) Culture LC 872063 CDM 306 RC facility both 7.5 7.5 Gross Charge Type: NIHD_Hosp_Profee_Price "Parasite Exam, Blood LC" 87207 CDM 306 RC facility both 4.11 4.11 Gross Charge Type: NIHD_Hosp_Profee_Price "Parasite Exam, Blood LC" 87207 CDM 306 RC facility both 4.11 4.11 Gross Charge Type: NIHD_Hosp_Profee_Price Ova+Parasite Status Prelim LC 87209 CDM 300 RC facility both 4.38 4.38 Gross Charge Type: NIHD_Hosp_Profee_Price Ova+Parasite Status Prelim LC 87209 CDM 300 RC facility both 4.38 4.38 Gross Charge Type: NIHD_Hosp_Profee_Price KOH Vaginal POCT 87210 CDM 521 RC 87210 HCPCS facility both 84 84 Gross Charge Type: NIHD_RHC_Price KOH Vaginal POCT 87210 CDM 521 RC 87210 HCPCS facility both 84 84 Gross Charge Type: NIHD_Clinic_Price KOH Vaginal POCT 87210 CDM 306 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price KOH Vaginal POCT 87210 CDM 306 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price Fecal WBC 872101 CDM 301 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price Fecal WBC 872101 CDM 301 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price Wet Mount 872102 CDM 306 RC facility both TC 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price Wet Mount 872102 CDM 306 RC facility both TC 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price Wet Prep POCT 872103 CDM 521 RC 87210 HCPCS facility both 84 84 Gross Charge Type: NIHD_RHC_Price Wet Prep POCT 872103 CDM 521 RC 87210 HCPCS facility both 84 84 Gross Charge Type: NIHD_Clinic_Price Wet Prep POCT 872103 CDM 306 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price Wet Prep POCT 872103 CDM 306 RC facility both 84 84 Gross Charge Type: NIHD_Hosp_Profee_Price "KOH Hair, Skin, Nails POCT" 872201 CDM 521 RC 87220 HCPCS facility both 63 63 Gross Charge Type: NIHD_RHC_Price "KOH Hair, Skin, Nails POCT" 872201 CDM 521 RC 87220 HCPCS facility both 63 63 Gross Charge Type: NIHD_Clinic_Price "KOH Hair, Skin, Nails POCT" 872201 CDM 300 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price "KOH Hair, Skin, Nails POCT" 872201 CDM 300 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price "KOH Prep (Hair, Skin, Nails)" 872202 CDM 306 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price "KOH Prep (Hair, Skin, Nails)" 872202 CDM 306 RC facility both 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price HSV Culture with Type LC 87254 CDM 87254 HCPCS facility both 20.36 20.36 Gross Charge Type: NIHD_Clinic_Price HSV Culture with Type LC 87254 CDM 301 RC facility both 20.36 20.36 Gross Charge Type: NIHD_Hosp_Profee_Price HSV Culture with Type LC 87254 CDM 301 RC facility both 20.36 20.36 Gross Charge Type: NIHD_Hosp_Profee_Price Varicella Zoster Cult Rapid LC 87255 CDM 87255 HCPCS facility both 20.37 20.37 Gross Charge Type: NIHD_Clinic_Price Varicella Zoster Cult Rapid LC 87255_301 CDM 301 RC facility both 20.37 20.37 Gross Charge Type: NIHD_Hosp_Profee_Price Varicella Zoster Cult Rapid LC 87255_301 CDM 301 RC facility both 20.37 20.37 Gross Charge Type: NIHD_Hosp_Profee_Price HSV Culture w/o Typing LC 87255_306 CDM 306 RC facility both 14 14 Gross Charge Type: NIHD_Hosp_Profee_Price HSV Culture w/o Typing LC 87255_306 CDM 306 RC facility both 14 14 Gross Charge Type: NIHD_Hosp_Profee_Price HSV Culture and Typing LC 872551 CDM 306 RC facility both 14 14 Gross Charge Type: NIHD_Hosp_Profee_Price HSV Culture and Typing LC 872551 CDM 306 RC facility both 14 14 Gross Charge Type: NIHD_Hosp_Profee_Price Clostridium Difficile 873241 CDM 300 RC facility both 142 142 Gross Charge Type: NIHD_Hosp_Profee_Price Clostridium Difficile 873241 CDM 300 RC facility both 142 142 Gross Charge Type: NIHD_Hosp_Profee_Price "C difficile Toxins A+B, EIA LC" 873242 CDM 300 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price "C difficile Toxins A+B, EIA LC" 873242 CDM 300 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price Giardia/Crypto Ag 87328 CDM 306 RC facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price Giardia/Crypto Ag 87328 CDM 306 RC facility both 219 219 Gross Charge Type: NIHD_Hosp_Profee_Price "H. pylori Stool Ag, EIA LC" 87338 CDM 306 RC facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price "H. pylori Stool Ag, EIA LC" 87338 CDM 306 RC facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price HBsAg Screen LC 873401 CDM 306 RC facility both 2.35 2.35 Gross Charge Type: NIHD_Hosp_Profee_Price HBsAg Screen LC 873401 CDM 306 RC facility both 2.35 2.35 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, Tot LC" 873402 CDM 306 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price "Hep B Core Ab, Tot LC" 873402 CDM 306 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price Hep B Surf Ag Scr LC 873501 CDM 306 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price Hep B Surf Ag Scr LC 873501 CDM 306 RC facility both 3.02 3.02 Gross Charge Type: NIHD_Hosp_Profee_Price Hep Be Ag LC 873502 CDM 300 RC facility both 2.35 2.35 Gross Charge Type: NIHD_Hosp_Profee_Price Hep Be Ag LC 873502 CDM 300 RC facility both 2.35 2.35 Gross Charge Type: NIHD_Hosp_Profee_Price HIV Ag/Ab w/ Reflex to Conf LC 87389 CDM 306 RC facility both 6.95 6.95 Gross Charge Type: NIHD_Hosp_Profee_Price HIV Ag/Ab w/ Reflex to Conf LC 87389 CDM 306 RC facility both 6.95 6.95 Gross Charge Type: NIHD_Hosp_Profee_Price HIV Ag/Ab Combo 1/2 Screen 873891 CDM 87389 HCPCS facility both 139 139 Gross Charge Type: NIHD_Clinic_Price HIV Ag/Ab Combo 1/2 Screen 873891 CDM 300 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price HIV Ag/Ab Combo 1/2 Screen 873891 CDM 300 RC facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price L. pneumophila Serogp 1 Ur Ag LC 87449 CDM 306 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price L. pneumophila Serogp 1 Ur Ag LC 87449 CDM 306 RC facility both 14.66 14.66 Gross Charge Type: NIHD_Hosp_Profee_Price Campylobacter Antigen 874491 CDM 306 RC facility both 144 144 Gross Charge Type: NIHD_Hosp_Profee_Price Campylobacter Antigen 874491 CDM 306 RC facility both 144 144 Gross Charge Type: NIHD_Hosp_Profee_Price Shiga Toxin 1 Test 874492 CDM 306 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price Shiga Toxin 1 Test 874492 CDM 306 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price Lyme (B. burgdorferi) PCR LC 87476 CDM 306 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price Lyme (B. burgdorferi) PCR LC 87476 CDM 306 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price NuSwab Vaginitis Plus (VG+) LC 87491 CDM 87491 HCPCS facility both 161 161 Gross Charge Type: NIHD_Clinic_Price NuSwab Vaginitis Plus (VG+) LC 87491 CDM 301 RC facility both 161 161 Gross Charge Type: NIHD_Hosp_Profee_Price NuSwab Vaginitis Plus (VG+) LC 87491 CDM 301 RC facility both 161 161 Gross Charge Type: NIHD_Hosp_Profee_Price "Chlamydia Trachomatis, NAA LC" 874911 CDM 300 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "Chlamydia Trachomatis, NAA LC" 874911 CDM 300 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price Chlamydia trachomatis DNA -GeneXpert 874913 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Chlamydia trachomatis DNA -GeneXpert 874913 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "Neisseria gonorrhoeae, NAA, Pharyn LC" 874914 CDM 306 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "Neisseria gonorrhoeae, NAA, Pharyn LC" 874914 CDM 306 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price Clostridium Difficile (GeneXpert) 87493 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Clostridium Difficile (GeneXpert) 87493 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price CMV PCR LC 87496 CDM 306 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price CMV PCR LC 87496 CDM 306 RC facility both 52 52 Gross Charge Type: NIHD_Hosp_Profee_Price CMV Quant DNA PCR (Plasma) LC 87497 CDM 306 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price CMV Quant DNA PCR (Plasma) LC 87497 CDM 306 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price Flu A/B (GeneXpert) 87502 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Flu A/B (GeneXpert) 87502 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "Iodine, Serum or Plasma LC" 87507 CDM 306 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price "Iodine, Serum or Plasma LC" 87507 CDM 306 RC facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price "HBV Real-Time PCR, Quant LC" 87517 CDM 306 RC facility both 73.31 73.31 Gross Charge Type: NIHD_Hosp_Profee_Price "HBV Real-Time PCR, Quant LC" 87517 CDM 306 RC facility both 73.31 73.31 Gross Charge Type: NIHD_Hosp_Profee_Price HBV DNA RealTime Abbott LC 875171 CDM 306 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price HBV DNA RealTime Abbott LC 875171 CDM 306 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price HCV RNA NAA Qualitative LC 87521 CDM 306 RC facility both 52.94 52.94 Gross Charge Type: NIHD_Hosp_Profee_Price HCV RNA NAA Qualitative LC 87521 CDM 306 RC facility both 52.94 52.94 Gross Charge Type: NIHD_Hosp_Profee_Price .HCV RNA NAA Qualitative LC 875211 CDM 306 RC facility both 108.34 108.34 Gross Charge Type: NIHD_Hosp_Profee_Price .HCV RNA NAA Qualitative LC 875211 CDM 306 RC facility both 108.34 108.34 Gross Charge Type: NIHD_Hosp_Profee_Price ".HCV RT-PCR,Quant(Non-Graph) LC" 87522 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price ".HCV RT-PCR,Quant(Non-Graph) LC" 87522 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price "HCV RNA by PCR, Qn Rfx Geno LC" 875221_301 CDM 301 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price "HCV RNA by PCR, Qn Rfx Geno LC" 875221_301 CDM 301 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price ".HCV RT-PCR, Quant (Non-Graph) LC" 875221_306 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price ".HCV RT-PCR, Quant (Non-Graph) LC" 875221_306 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price HCV RealTime Abbott LC 875222 CDM 306 RC facility both 200 200 Gross Charge Type: NIHD_Hosp_Profee_Price HCV RealTime Abbott LC 875222 CDM 306 RC facility both 200 200 Gross Charge Type: NIHD_Hosp_Profee_Price "HCV RNA by PCR, Qn Rfx Geno GRAPH LC" 875223 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price "HCV RNA by PCR, Qn Rfx Geno GRAPH LC" 875223 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price HCV RNA PCR Rfx NS5B LC 875225 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price HCV RNA PCR Rfx NS5B LC 875225 CDM 306 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price "HCV RT-PCR, Quant (Graph) LC" 875226 CDM 306 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price "HCV RT-PCR, Quant (Graph) LC" 875226 CDM 306 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price HSV 1/2 PCR LC 87529 CDM 301 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price HSV 1/2 PCR LC 87529 CDM 301 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Herpes Simplex Virus (HSV) Types 1/2, DNA PCR 138651 LC - 87529" 875291_1 CDM 301 RC 87529 HCPCS facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Herpes Simplex Virus (HSV) Types 1/2, DNA PCR 138651 LC - 87529" 875291_1 CDM 301 RC 87529 HCPCS facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "87529 - Herpes Simplex Virus (HSV) and Varicella Zoster Virus (VZV) Profile (Lesions), PCR 139367 LC" 875291_2 CDM 301 RC 87529 HCPCS facility both 41.29 41.29 Gross Charge Type: NIHD_Hosp_Profee_Price "87529 - Herpes Simplex Virus (HSV) and Varicella Zoster Virus (VZV) Profile (Lesions), PCR 139367 LC" 875291_2 CDM 301 RC 87529 HCPCS facility both 41.29 41.29 Gross Charge Type: NIHD_Hosp_Profee_Price HSV and VZV PCR Panel LC 875292 CDM 301 RC facility both 41.29 41.29 Gross Charge Type: NIHD_Hosp_Profee_Price HSV and VZV PCR Panel LC 875292 CDM 301 RC facility both 41.29 41.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Herpes Simplex Virus (HSV) Types 1/2, Cerebrospinal Fluid (CSF), DNA PCR #139800" 875295 CDM 301 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Herpes Simplex Virus (HSV) Types 1/2, Cerebrospinal Fluid (CSF), DNA PCR #139800" 875295 CDM 301 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "RNA, Real Time PCR (Non-Graph) LC" 87536 CDM 300 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price "RNA, Real Time PCR (Non-Graph) LC" 87536 CDM 300 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price "Human Immunodeficiency Virus 1, Quant, RT PCR (Graph) LC" 875361 CDM 300 RC facility both 60 60 Gross Charge Type: NIHD_Hosp_Profee_Price "Human Immunodeficiency Virus 1, Quant, RT PCR (Graph) LC" 875361 CDM 300 RC facility both 60 60 Gross Charge Type: NIHD_Hosp_Profee_Price RealTime Abbott LC 875362 CDM 300 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price RealTime Abbott LC 875362 CDM 300 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price CMC THUMB BRACE FOR RELIEF LEFT SIZE 3 8756321 CDM 274 RC L3924 HCPCS facility both 317 317 Gross Charge Type: NIHD_RHC_Price CMC THUMB BRACE FOR RELIEF LEFT SIZE 3 8756321 CDM 274 RC L3924 HCPCS facility both 317 317 Gross Charge Type: NIHD_Clinic_Price CMC THUMB BRACE FOR RELIEF LEFT SIZE 3 8756321 CDM 274 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price CMC THUMB BRACE FOR RELIEF LEFT SIZE 3 8756321 CDM 274 RC facility both 317 317 Gross Charge Type: NIHD_Hosp_Profee_Price "Neisseria Gonorrhoeae, NAA LC" 87591 CDM 300 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "Neisseria Gonorrhoeae, NAA LC" 87591 CDM 300 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "Chlamydia trachomatis, NAA, Pharyn LC" 875911 CDM 306 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price "Chlamydia trachomatis, NAA, Pharyn LC" 875911 CDM 306 RC facility both 9 9 Gross Charge Type: NIHD_Hosp_Profee_Price Neisseria gonorrhoeae DNA -GeneXpert 875912 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Neisseria gonorrhoeae DNA -GeneXpert 875912 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19)/Flu/RSV (GeneXpert) 87631 CDM 306 RC facility both 472 472 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19)/Flu/RSV (GeneXpert) 87631 CDM 306 RC facility both 472 472 Gross Charge Type: NIHD_Hosp_Profee_Price RSV (GeneXpert) 87634 CDM 306 RC facility both 137 137 Gross Charge Type: NIHD_Hosp_Profee_Price RSV (GeneXpert) 87634 CDM 306 RC facility both 137 137 Gross Charge Type: NIHD_Hosp_Profee_Price "2019 Novel Coronavirus (CoVID-19), NAA LC" 87635 CDM 300 RC facility both 51.31 51.31 Gross Charge Type: NIHD_Hosp_Profee_Price "2019 Novel Coronavirus (CoVID-19), NAA LC" 87635 CDM 300 RC facility both 51.31 51.31 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19) (Accula) POCT 876351 CDM 87635 HCPCS facility both 105 105 Gross Charge Type: NIHD_Clinic_Price SARS-CoV-2 (COVID-19) (Accula) 876351 CDM 300 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19) (Accula) 876351 CDM 300 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19) PCR (GeneXpert) 876352 CDM 306 RC facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19) PCR (GeneXpert) 876352 CDM 306 RC facility both 141 141 Gross Charge Type: NIHD_Hosp_Profee_Price "COVID-19, Flu A+B and RSV LC" 87637 CDM 300 RC facility both 143 143 Gross Charge Type: NIHD_Hosp_Profee_Price "COVID-19, Flu A+B and RSV LC" 87637 CDM 300 RC facility both 143 143 Gross Charge Type: NIHD_Hosp_Profee_Price MRSA Screen (GeneXpert) 87641 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price MRSA Screen (GeneXpert) 87641 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Group A Strep Culture AMS 876511 CDM 306 RC facility both 152 152 Gross Charge Type: NIHD_Hosp_Profee_Price Group A Strep Culture AMS 876511 CDM 306 RC facility both 152 152 Gross Charge Type: NIHD_Hosp_Profee_Price Strep A (GeneXpert) 876512 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Strep A (GeneXpert) 876512 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Group B Strep (GeneXpert) 87653 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Group B Strep (GeneXpert) 87653 CDM 306 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Trich vag by NAA LC 87661 CDM 306 RC facility both 33 33 Gross Charge Type: NIHD_Hosp_Profee_Price Trich vag by NAA LC 87661 CDM 306 RC facility both 33 33 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: ICU OB 8775062 CDM 206 RC facility both 5240 5240 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: ICU OB 8775062 CDM 206 RC facility both 5240 5240 Gross Charge Type: NIHD_Hosp_Profee_Price Plasmodium sp. PCR LC 87798 CDM 306 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price Plasmodium sp. PCR LC 87798 CDM 306 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price .Plasmodium sp Reflex 139480 LC 877981 CDM 306 RC facility both 300.9 300.9 Gross Charge Type: NIHD_Hosp_Profee_Price .Plasmodium sp Reflex 139480 LC 877981 CDM 306 RC facility both 300.9 300.9 Gross Charge Type: NIHD_Hosp_Profee_Price B.pertussis B.parapertussis PCR LC 877982 CDM 306 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price B.pertussis B.parapertussis PCR LC 877982 CDM 306 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price "JC Virus DNA,PCR (Whole Blood) LC" 877983 CDM 306 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price "JC Virus DNA,PCR (Whole Blood) LC" 877983 CDM 306 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price "Norovirus, RT-PCR LC" 877984 CDM 306 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price "Norovirus, RT-PCR LC" 877984 CDM 306 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price VZV Real Time PCR LC 877985 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price VZV Real Time PCR LC 877985 CDM 301 RC facility both 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price BK Quant PCR (Urine) LC 87799 CDM 306 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price BK Quant PCR (Urine) LC 87799 CDM 306 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price BKV Quant PCR (Plasma) LC 877991 CDM 306 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price BKV Quant PCR (Plasma) LC 877991 CDM 306 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price Influenza A & B POCT 87804 CDM 521 RC 87804 HCPCS facility both 116 116 Gross Charge Type: NIHD_RHC_Price Influenza A & B POCT 87804 CDM 521 RC 87804 HCPCS facility both 116 116 Gross Charge Type: NIHD_Clinic_Price Influenza A & B POCT 87804 CDM 300 RC facility both 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price Influenza A & B POCT 87804 CDM 300 RC facility both 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price COVID-19 SARS Ag (QuickVue) 87811 CDM 306 RC 87811 HCPCS facility both 82 82 Gross Charge Type: NIHD_RHC_Price COVID-19 SARS Ag (QuickVue) 87811 CDM 306 RC 87811 HCPCS facility both 82 82 Gross Charge Type: NIHD_Clinic_Price COVID-19 SARS Ag (QuickVue) 87811 CDM 306 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price COVID-19 SARS Ag (QuickVue) 87811 CDM 306 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV or CoV-2 (COVID-19) Antigen (Binax) POCT 878111 CDM 87811 HCPCS facility both 82 82 Gross Charge Type: NIHD_RHC_Price SARS-CoV or CoV-2 (COVID-19) Antigen (Binax) POCT 878111 CDM 87811 HCPCS facility both 82 82 Gross Charge Type: NIHD_Clinic_Price SARS-CoV or CoV-2 (COVID-19) Antigen (Binax) POCT 878111 CDM 301 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV or CoV-2 (COVID-19) Antigen (Binax) POCT 878111 CDM 301 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price 87880 Infectious agent antigen detection by immunoassay with direct optical observation; Streptococc 878801 CDM 300 RC 87880 HCPCS facility both 64 64 Gross Charge Type: NIHD_RHC_Price 87880 Infectious agent antigen detection by immunoassay with direct optical observation; Streptococc 878801 CDM 300 RC 87880 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price Strep A POCT 878802 CDM 300 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Strep A POCT 878802 CDM 300 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Rapid Strep Clinic POC (RE) 878803 CDM 300 RC 87880 HCPCS facility both 100 100 Gross Charge Type: NIHD_RHC_Price Rapid Strep Clinic POC (RE) 878803 CDM 300 RC 87880 HCPCS facility both 100 100 Gross Charge Type: NIHD_Clinic_Price Strep A Clinic POC (RE) 878804 CDM 300 RC 87880 HCPCS facility both 100 100 Gross Charge Type: NIHD_RHC_Price Strep A Clinic POC (RE) 878804 CDM 300 RC 87880 HCPCS facility both 100 100 Gross Charge Type: NIHD_Clinic_Price Streptococcus pneumoniae Ag LC 87899 CDM 306 RC facility both 18.5 18.5 Gross Charge Type: NIHD_Hosp_Profee_Price Streptococcus pneumoniae Ag LC 87899 CDM 306 RC facility both 18.5 18.5 Gross Charge Type: NIHD_Hosp_Profee_Price .Cryptococcus Ag Titer 183036 LC 878991 CDM 306 RC facility both 12.63 12.63 Gross Charge Type: NIHD_Hosp_Profee_Price .Cryptococcus Ag Titer 183036 LC 878991 CDM 306 RC facility both 12.63 12.63 Gross Charge Type: NIHD_Hosp_Profee_Price .Cryptococcus Ag Titer CSF 183018 LC 878992 CDM 306 RC facility both 12.63 12.63 Gross Charge Type: NIHD_Hosp_Profee_Price .Cryptococcus Ag Titer CSF 183018 LC 878992 CDM 306 RC facility both 12.63 12.63 Gross Charge Type: NIHD_Hosp_Profee_Price "Cryptococcus Antigen, CSF LC" 878993 CDM 306 RC facility both 8.46 8.46 Gross Charge Type: NIHD_Hosp_Profee_Price "Cryptococcus Antigen, CSF LC" 878993 CDM 306 RC facility both 8.46 8.46 Gross Charge Type: NIHD_Hosp_Profee_Price "Cryptococcus Antigen, Serum LC" 878994 CDM 306 RC facility both 12.25 12.25 Gross Charge Type: NIHD_Hosp_Profee_Price "Cryptococcus Antigen, Serum LC" 878994 CDM 306 RC facility both 12.25 12.25 Gross Charge Type: NIHD_Hosp_Profee_Price HCV NS5B Drug Resistance Assay LC 879001 CDM 306 RC facility both 39.5 39.5 Gross Charge Type: NIHD_Hosp_Profee_Price HCV NS5B Drug Resistance Assay LC 879001 CDM 306 RC facility both 39.5 39.5 Gross Charge Type: NIHD_Hosp_Profee_Price HCV NS5B Resist Assay Interp LC 879002 CDM 306 RC facility both 39.5 39.5 Gross Charge Type: NIHD_Hosp_Profee_Price HCV NS5B Resist Assay Interp LC 879002 CDM 306 RC facility both 39.5 39.5 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Genotyping Non Reflex LC 87902 CDM 306 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price HCV Genotyping Non Reflex LC 87902 CDM 306 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price .Hepatitis C Genotype LC 879021 CDM 306 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price .Hepatitis C Genotype LC 879021 CDM 306 RC facility both 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price "Haemophilus influenzae B, IgG LC" 8799688 CDM 301 RC facility both 57.02 57.02 Gross Charge Type: NIHD_Hosp_Profee_Price "Haemophilus influenzae B, IgG LC" 8799688 CDM 301 RC facility both 57.02 57.02 Gross Charge Type: NIHD_Hosp_Profee_Price 88104 AP Bill Non-Gyn Cytology 88104 CDM 971 RC 88104 HCPCS facility both 26 79 79 Gross Charge Type: NIHD_Hosp_Tech_Price 88104 AP Bill Non-Gyn Cytology 88104 CDM 971 RC 88104 HCPCS facility both 26 79 79 Gross Charge Type: NIHD_Hosp_Tech_Price 88104 AP Bill Non-Gyn Cytology 88104 CDM 971 RC 88104 HCPCS facility both 26 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 88104 AP Bill Non-Gyn Cytology 88104 CDM 971 RC 88104 HCPCS facility both 26 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 88104 AP Bill Non-Gyn Cytology 88104_310 CDM 310 RC 88104 HCPCS facility both TC 79 79 Gross Charge Type: NIHD_Hosp_Tech_Price 88104 AP Bill Non-Gyn Cytology 88104_310 CDM 310 RC 88104 HCPCS facility both TC 79 79 Gross Charge Type: NIHD_Hosp_Tech_Price 88104 AP Bill Non-Gyn Cytology 88104_310 CDM 310 RC 88104 HCPCS facility both TC 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 88104 AP Bill Non-Gyn Cytology 88104_310 CDM 310 RC 88104 HCPCS facility both TC 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 88108 AP Bill Non-Gyn Cytology Concentration Technique 88108 CDM 971 RC 88108 HCPCS facility both 26 204 204 Gross Charge Type: NIHD_Hosp_Tech_Price 88108 AP Bill Non-Gyn Cytology Concentration Technique 88108 CDM 971 RC 88108 HCPCS facility both 26 204 204 Gross Charge Type: NIHD_Hosp_Tech_Price 88108 AP Bill Non-Gyn Cytology Concentration Technique 88108 CDM 971 RC 88108 HCPCS facility both 26 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price 88108 AP Bill Non-Gyn Cytology Concentration Technique 88108 CDM 971 RC 88108 HCPCS facility both 26 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price 88108 AP Bill Non-Gyn Cytology Concentration Technique 88108_310 CDM 310 RC 88108 HCPCS facility both TC 204 204 Gross Charge Type: NIHD_Hosp_Tech_Price 88108 AP Bill Non-Gyn Cytology Concentration Technique 88108_310 CDM 310 RC 88108 HCPCS facility both TC 204 204 Gross Charge Type: NIHD_Hosp_Tech_Price 88108 AP Bill Non-Gyn Cytology Concentration Technique 88108_310 CDM 310 RC 88108 HCPCS facility both TC 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price 88108 AP Bill Non-Gyn Cytology Concentration Technique 88108_310 CDM 310 RC 88108 HCPCS facility both TC 50 50 Gross Charge Type: NIHD_Hosp_Profee_Price 88112 AP Bill Non-Gyn Cytology Cell Enhancement w/ Interp 88112 CDM 310 RC facility both TC 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 88112 AP Bill Non-Gyn Cytology Cell Enhancement w/ Interp 88112 CDM 310 RC facility both TC 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE T SCOPE X-LARGE 27IN HINGED 8815111 CDM 274 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price KNEE BRACE T SCOPE X-LARGE 27IN HINGED 8815111 CDM 274 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price Pathology Smear Consult 88160 CDM 971 RC 88160 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Pathology Smear Consult 88160 CDM 971 RC 88160 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Post Vas Path Exam 881601 CDM 310 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Post Vas Path Exam 881601 CDM 310 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 88172 AP Bill FNA Immediate Read 88172 CDM 971 RC 88172 HCPCS facility both 26 270 270 Gross Charge Type: NIHD_Hosp_Tech_Price 88172 AP Bill FNA Immediate Read 88172 CDM 971 RC 88172 HCPCS facility both 26 270 270 Gross Charge Type: NIHD_Hosp_Tech_Price 88172 AP Bill FNA Immediate Read 88172 CDM 971 RC 88172 HCPCS facility both 26 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 88172 AP Bill FNA Immediate Read 88172 CDM 971 RC 88172 HCPCS facility both 26 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 88172 AP Bill FNA Immediate Read 88172_311 CDM 311 RC 88172 HCPCS facility both TC 270 270 Gross Charge Type: NIHD_Hosp_Tech_Price 88172 AP Bill FNA Immediate Read 88172_311 CDM 311 RC 88172 HCPCS facility both TC 270 270 Gross Charge Type: NIHD_Hosp_Tech_Price 88172 AP Bill FNA Immediate Read 88172_311 CDM 311 RC 88172 HCPCS facility both TC 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 88172 AP Bill FNA Immediate Read 88172_311 CDM 311 RC 88172 HCPCS facility both TC 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 88173 AP Bill FNA Interp and report 88173 CDM 971 RC 88173 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Tech_Price 88173 AP Bill FNA Interp and report 88173 CDM 971 RC 88173 HCPCS facility both 26 146 146 Gross Charge Type: NIHD_Hosp_Tech_Price 88173 AP Bill FNA Interp and report 88173 CDM 971 RC 88173 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 88173 AP Bill FNA Interp and report 88173 CDM 971 RC 88173 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 88173 AP Bill FNA Interp and report 88173_311 CDM 311 RC 88173 HCPCS facility both TC 146 146 Gross Charge Type: NIHD_Hosp_Tech_Price 88173 AP Bill FNA Interp and report 88173_311 CDM 311 RC 88173 HCPCS facility both TC 146 146 Gross Charge Type: NIHD_Hosp_Tech_Price 88173 AP Bill FNA Interp and report 88173_311 CDM 311 RC 88173 HCPCS facility both TC 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 88173 AP Bill FNA Interp and report 88173_311 CDM 311 RC 88173 HCPCS facility both TC 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price CMP (14) LC 88230_1 CDM 300 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price CMP (14) LC 88230_1 CDM 300 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price "Chromosome, Routine LC" 88230_2 CDM 300 RC facility both 106.45 106.45 Gross Charge Type: NIHD_Hosp_Profee_Price "Chromosome, Routine LC" 88230_2 CDM 300 RC facility both 106.45 106.45 Gross Charge Type: NIHD_Hosp_Profee_Price 88300 AP Bill Surgical Pathology Level I Complexity 883001 CDM 971 RC 88300 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Tech_Price 88300 AP Bill Surgical Pathology Level I Complexity 883001 CDM 971 RC 88300 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Tech_Price 88300 AP Bill Surgical Pathology Level I Complexity 883001 CDM 971 RC 88300 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 88300 AP Bill Surgical Pathology Level I Complexity 883001 CDM 971 RC 88300 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 88300 AP Bill Surgical Pathology Level I Complexity 883001_310 CDM 310 RC 88300 HCPCS facility both TC 67 67 Gross Charge Type: NIHD_Hosp_Tech_Price 88300 AP Bill Surgical Pathology Level I Complexity 883001_310 CDM 310 RC 88300 HCPCS facility both TC 67 67 Gross Charge Type: NIHD_Hosp_Tech_Price 88300 AP Bill Surgical Pathology Level I Complexity 883001_310 CDM 310 RC 88300 HCPCS facility both TC 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 88300 AP Bill Surgical Pathology Level I Complexity 883001_310 CDM 310 RC 88300 HCPCS facility both TC 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 88300 AP Bill Surgical path gross 883002 CDM 971 RC 88300 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Tech_Price 88300 AP Bill Surgical path gross 883002 CDM 971 RC 88300 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Tech_Price 88300 AP Bill Surgical path gross 883002 CDM 971 RC 88300 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 88300 AP Bill Surgical path gross 883002 CDM 971 RC 88300 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 88300 AP Bill Surgical path gross 883002_310 CDM 310 RC 88300 HCPCS facility both TC 67 67 Gross Charge Type: NIHD_Hosp_Tech_Price 88300 AP Bill Surgical path gross 883002_310 CDM 310 RC 88300 HCPCS facility both TC 67 67 Gross Charge Type: NIHD_Hosp_Tech_Price 88300 AP Bill Surgical path gross 883002_310 CDM 310 RC 88300 HCPCS facility both TC 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 88300 AP Bill Surgical path gross 883002_310 CDM 310 RC 88300 HCPCS facility both TC 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 88302 AP Bill Surg Level II 88302_1 CDM 971 RC 88302 HCPCS facility both 26 201 201 Gross Charge Type: NIHD_Hosp_Tech_Price 88302 AP Bill Surg Level II 88302_1 CDM 971 RC 88302 HCPCS facility both 26 201 201 Gross Charge Type: NIHD_Hosp_Tech_Price 88302 AP Bill Surg Level II 88302_1 CDM 971 RC 88302 HCPCS facility both 26 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price 88302 AP Bill Surg Level II 88302_1 CDM 971 RC 88302 HCPCS facility both 26 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price 88302 AP Bill Surgical Pathology Level II Complexity 88302_2 CDM 971 RC 88302 HCPCS facility both 26 211 211 Gross Charge Type: NIHD_Hosp_Tech_Price 88302 AP Bill Surgical Pathology Level II Complexity 88302_2 CDM 971 RC 88302 HCPCS facility both 26 211 211 Gross Charge Type: NIHD_Hosp_Tech_Price 88302 AP Bill Surgical Pathology Level II Complexity 88302_2 CDM 971 RC 88302 HCPCS facility both 26 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price 88302 AP Bill Surgical Pathology Level II Complexity 88302_2 CDM 971 RC 88302 HCPCS facility both 26 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price 88302 AP Bill Surg Level II 88302_310_1 CDM 310 RC 88302 HCPCS facility both TC 201 201 Gross Charge Type: NIHD_Hosp_Tech_Price 88302 AP Bill Surg Level II 88302_310_1 CDM 310 RC 88302 HCPCS facility both TC 201 201 Gross Charge Type: NIHD_Hosp_Tech_Price 88302 AP Bill Surg Level II 88302_310_1 CDM 310 RC 88302 HCPCS facility both TC 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price 88302 AP Bill Surg Level II 88302_310_1 CDM 310 RC 88302 HCPCS facility both TC 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price 88302 AP Bill Surgical Pathology Level II Complexity 88302_310_2 CDM 310 RC 88302 HCPCS facility both TC 211 211 Gross Charge Type: NIHD_Hosp_Tech_Price 88302 AP Bill Surgical Pathology Level II Complexity 88302_310_2 CDM 310 RC 88302 HCPCS facility both TC 211 211 Gross Charge Type: NIHD_Hosp_Tech_Price 88302 AP Bill Surgical Pathology Level II Complexity 88302_310_2 CDM 310 RC 88302 HCPCS facility both TC 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price 88302 AP Bill Surgical Pathology Level II Complexity 88302_310_2 CDM 310 RC 88302 HCPCS facility both TC 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price 88304 AP Bill Surgical Pathology Level III Complexity 88304 CDM 971 RC 88304 HCPCS facility both 26 307 307 Gross Charge Type: NIHD_Hosp_Tech_Price 88304 AP Bill Surgical Pathology Level III Complexity 88304 CDM 971 RC 88304 HCPCS facility both 26 307 307 Gross Charge Type: NIHD_Hosp_Tech_Price 88304 AP Bill Surgical Pathology Level III Complexity 88304 CDM 971 RC 88304 HCPCS facility both 26 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 88304 AP Bill Surgical Pathology Level III Complexity 88304 CDM 971 RC 88304 HCPCS facility both 26 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 88304 AP Bill Surgical Pathology Level III Complexity 88304_310 CDM 310 RC 88304 HCPCS facility both TC 307 307 Gross Charge Type: NIHD_Hosp_Tech_Price 88304 AP Bill Surgical Pathology Level III Complexity 88304_310 CDM 310 RC 88304 HCPCS facility both TC 307 307 Gross Charge Type: NIHD_Hosp_Tech_Price 88304 AP Bill Surgical Pathology Level III Complexity 88304_310 CDM 310 RC 88304 HCPCS facility both TC 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 88304 AP Bill Surgical Pathology Level III Complexity 88304_310 CDM 310 RC 88304 HCPCS facility both TC 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price 88305 AP Bill Surgical Pathology Level IV Complexity 88305 CDM 971 RC 88305 HCPCS facility both 26 349 349 Gross Charge Type: NIHD_Hosp_Tech_Price 88305 AP Bill Surgical Pathology Level IV Complexity 88305 CDM 971 RC 88305 HCPCS facility both 26 349 349 Gross Charge Type: NIHD_Hosp_Tech_Price 88305 AP Bill Surgical Pathology Level IV Complexity 88305 CDM 971 RC 88305 HCPCS facility both 26 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price 88305 AP Bill Surgical Pathology Level IV Complexity 88305 CDM 971 RC 88305 HCPCS facility both 26 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price 88305 AP Bill Surgical Pathology Level IV Complexity 88305_310 CDM 310 RC 88305 HCPCS facility both TC 349 349 Gross Charge Type: NIHD_Hosp_Tech_Price 88305 AP Bill Surgical Pathology Level IV Complexity 88305_310 CDM 310 RC 88305 HCPCS facility both TC 349 349 Gross Charge Type: NIHD_Hosp_Tech_Price 88305 AP Bill Surgical Pathology Level IV Complexity 88305_310 CDM 310 RC 88305 HCPCS facility both TC 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price 88305 AP Bill Surgical Pathology Level IV Complexity 88305_310 CDM 310 RC 88305 HCPCS facility both TC 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price 88307 AP Bill Surgical Pathology Level V Complexity 88307 CDM 971 RC 88307 HCPCS facility both 26 475 475 Gross Charge Type: NIHD_Hosp_Tech_Price 88307 AP Bill Surgical Pathology Level V Complexity 88307 CDM 971 RC 88307 HCPCS facility both 26 475 475 Gross Charge Type: NIHD_Hosp_Tech_Price 88307 AP Bill Surgical Pathology Level V Complexity 88307 CDM 971 RC 88307 HCPCS facility both 26 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 88307 AP Bill Surgical Pathology Level V Complexity 88307 CDM 971 RC 88307 HCPCS facility both 26 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 88307 AP Bill Surgical Pathology Level V Complexity 88307_310 CDM 310 RC 88307 HCPCS facility both TC 475 475 Gross Charge Type: NIHD_Hosp_Tech_Price 88307 AP Bill Surgical Pathology Level V Complexity 88307_310 CDM 310 RC 88307 HCPCS facility both TC 475 475 Gross Charge Type: NIHD_Hosp_Tech_Price 88307 AP Bill Surgical Pathology Level V Complexity 88307_310 CDM 310 RC 88307 HCPCS facility both TC 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 88307 AP Bill Surgical Pathology Level V Complexity 88307_310 CDM 310 RC 88307 HCPCS facility both TC 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 88309 AP Bill Surgical Pathology Level VI Complexity 88309 CDM 971 RC 88309 HCPCS facility both 26 780 780 Gross Charge Type: NIHD_Hosp_Tech_Price 88309 AP Bill Surgical Pathology Level VI Complexity 88309 CDM 971 RC 88309 HCPCS facility both 26 780 780 Gross Charge Type: NIHD_Hosp_Tech_Price 88309 AP Bill Surgical Pathology Level VI Complexity 88309 CDM 971 RC 88309 HCPCS facility both 26 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 88309 AP Bill Surgical Pathology Level VI Complexity 88309 CDM 971 RC 88309 HCPCS facility both 26 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 88309 AP Bill Surgical Pathology Level VI Complexity 88309_310 CDM 310 RC 88309 HCPCS facility both TC 780 780 Gross Charge Type: NIHD_Hosp_Tech_Price 88309 AP Bill Surgical Pathology Level VI Complexity 88309_310 CDM 310 RC 88309 HCPCS facility both TC 780 780 Gross Charge Type: NIHD_Hosp_Tech_Price 88309 AP Bill Surgical Pathology Level VI Complexity 88309_310 CDM 310 RC 88309 HCPCS facility both TC 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 88309 AP Bill Surgical Pathology Level VI Complexity 88309_310 CDM 310 RC 88309 HCPCS facility both TC 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 88311 AP Bill Decalcification 88311 CDM 971 RC 88311 HCPCS facility both 26 47 47 Gross Charge Type: NIHD_Hosp_Tech_Price 88311 AP Bill Decalcification 88311 CDM 971 RC 88311 HCPCS facility both 26 47 47 Gross Charge Type: NIHD_Hosp_Tech_Price 88311 AP Bill Decalcification 88311 CDM 971 RC 88311 HCPCS facility both 26 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price 88311 AP Bill Decalcification 88311 CDM 971 RC 88311 HCPCS facility both 26 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price 88311 AP Bill Decalcification 88311_310 CDM 310 RC 88311 HCPCS facility both TC 47 47 Gross Charge Type: NIHD_Hosp_Tech_Price 88311 AP Bill Decalcification 88311_310 CDM 310 RC 88311 HCPCS facility both TC 47 47 Gross Charge Type: NIHD_Hosp_Tech_Price 88311 AP Bill Decalcification 88311_310 CDM 310 RC 88311 HCPCS facility both TC 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price 88311 AP Bill Decalcification 88311_310 CDM 310 RC 88311 HCPCS facility both TC 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price 88312 AP Bill Special Stains Group I 88312_310 CDM 310 RC 88312 HCPCS facility both TC 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price 88312 AP Bill Special Stains Group I 88312_310 CDM 310 RC 88312 HCPCS facility both TC 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price 88312 AP Bill Special Stain Group 1 Microorganisms I&R 88312_971 CDM 971 RC 88312 HCPCS facility both 26 101 101 Gross Charge Type: NIHD_Hosp_Tech_Price 88312 AP Bill Special Stain Group 1 Microorganisms I&R 88312_971 CDM 971 RC 88312 HCPCS facility both 26 101 101 Gross Charge Type: NIHD_Hosp_Tech_Price 88312 AP Bill Special Stain Group 1 Microorganisms I&R 88312_971 CDM 971 RC 88312 HCPCS facility both 26 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price 88312 AP Bill Special Stain Group 1 Microorganisms I&R 88312_971 CDM 971 RC 88312 HCPCS facility both 26 58 58 Gross Charge Type: NIHD_Hosp_Profee_Price 88313 AP Bill Special Stains Group II 88313_310 CDM 310 RC 88313 HCPCS facility both TC 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price 88313 AP Bill Special Stains Group II 88313_310 CDM 310 RC 88313 HCPCS facility both TC 170 170 Gross Charge Type: NIHD_Hosp_Profee_Price Special stains group 2 88313_971 CDM 971 RC 88313 HCPCS facility both 26 156 156 Gross Charge Type: NIHD_Hosp_Tech_Price Special stains group 2 88313_971 CDM 971 RC 88313 HCPCS facility both 26 156 156 Gross Charge Type: NIHD_Hosp_Tech_Price Special stains group 2 88313_971 CDM 971 RC 88313 HCPCS facility both 26 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price Special stains group 2 88313_971 CDM 971 RC 88313 HCPCS facility both 26 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 88329 AP Bill Non-Gyn Cytology Intraoperative Consult 88329 CDM 988 RC 88329 HCPCS facility both 26 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price 88329 AP Bill Non-Gyn Cytology Intraoperative Consult 88329 CDM 988 RC 88329 HCPCS facility both 26 79 79 Gross Charge Type: NIHD_Hosp_Profee_Price 88331 AP Bill Frozen single specimen 88331 CDM 971 RC 88331 HCPCS facility both 26 163 163 Gross Charge Type: NIHD_Hosp_Tech_Price 88331 AP Bill Frozen single specimen 88331 CDM 971 RC 88331 HCPCS facility both 26 163 163 Gross Charge Type: NIHD_Hosp_Tech_Price 88331 AP Bill Frozen single specimen 88331 CDM 971 RC 88331 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 88331 AP Bill Frozen single specimen 88331 CDM 971 RC 88331 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 88331 AP Bill Frozen single specimen 88331_310 CDM 310 RC 88331 HCPCS facility both TC 163 163 Gross Charge Type: NIHD_Hosp_Tech_Price 88331 AP Bill Frozen single specimen 88331_310 CDM 310 RC 88331 HCPCS facility both TC 163 163 Gross Charge Type: NIHD_Hosp_Tech_Price 88331 AP Bill Frozen single specimen 88331_310 CDM 310 RC 88331 HCPCS facility both TC 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 88331 AP Bill Frozen single specimen 88331_310 CDM 310 RC 88331 HCPCS facility both TC 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 88332 AP Bill Frozen add'l block 88332 CDM 971 RC 88332 HCPCS facility both 26 79 79 Gross Charge Type: NIHD_Hosp_Tech_Price 88332 AP Bill Frozen add'l block 88332 CDM 971 RC 88332 HCPCS facility both 26 79 79 Gross Charge Type: NIHD_Hosp_Tech_Price 88332 AP Bill Frozen add'l block 88332 CDM 971 RC 88332 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price 88332 AP Bill Frozen add'l block 88332 CDM 971 RC 88332 HCPCS facility both 26 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price 88332 AP Bill Frozen add'l block 88332_310 CDM 310 RC 88332 HCPCS facility both TC 79 79 Gross Charge Type: NIHD_Hosp_Tech_Price 88332 AP Bill Frozen add'l block 88332_310 CDM 310 RC 88332 HCPCS facility both TC 79 79 Gross Charge Type: NIHD_Hosp_Tech_Price 88332 AP Bill Frozen add'l block 88332_310 CDM 310 RC 88332 HCPCS facility both TC 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price 88332 AP Bill Frozen add'l block 88332_310 CDM 310 RC 88332 HCPCS facility both TC 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price 88333 AP Bill Non-Gyn Cytology Touch Prep 88333 CDM 971 RC 88333 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Tech_Price 88333 AP Bill Non-Gyn Cytology Touch Prep 88333 CDM 971 RC 88333 HCPCS facility both 26 151 151 Gross Charge Type: NIHD_Hosp_Tech_Price 88333 AP Bill Non-Gyn Cytology Touch Prep 88333 CDM 971 RC 88333 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 88333 AP Bill Non-Gyn Cytology Touch Prep 88333 CDM 971 RC 88333 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 88333 AP Bill Non-Gyn Cytology Touch Prep 88333_310 CDM 310 RC 88333 HCPCS facility both TC 151 151 Gross Charge Type: NIHD_Hosp_Tech_Price 88333 AP Bill Non-Gyn Cytology Touch Prep 88333_310 CDM 310 RC 88333 HCPCS facility both TC 151 151 Gross Charge Type: NIHD_Hosp_Tech_Price 88333 AP Bill Non-Gyn Cytology Touch Prep 88333_310 CDM 310 RC 88333 HCPCS facility both TC 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 88333 AP Bill Non-Gyn Cytology Touch Prep 88333_310 CDM 310 RC 88333 HCPCS facility both TC 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 88341 AP Bill Surg IPX (Add'l Antibody) 88341 CDM 971 RC 88341 HCPCS facility both 26 29 29 Gross Charge Type: NIHD_Hosp_Tech_Price 88341 AP Bill Surg IPX (Add'l Antibody) 88341 CDM 971 RC 88341 HCPCS facility both 26 29 29 Gross Charge Type: NIHD_Hosp_Tech_Price 88341 AP Bill Surg IPX (Add'l Antibody) 88341 CDM 971 RC 88341 HCPCS facility both 26 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 88341 AP Bill Surg IPX (Add'l Antibody) 88341 CDM 971 RC 88341 HCPCS facility both 26 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 88341 AP Bill Surg IPX (Add'l Antibody) 88341_310 CDM 310 RC 88341 HCPCS facility both TC 29 29 Gross Charge Type: NIHD_Hosp_Tech_Price 88341 AP Bill Surg IPX (Add'l Antibody) 88341_310 CDM 310 RC 88341 HCPCS facility both TC 29 29 Gross Charge Type: NIHD_Hosp_Tech_Price 88341 AP Bill Surg IPX (Add'l Antibody) 88341_310 CDM 310 RC 88341 HCPCS facility both TC 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 88341 AP Bill Surg IPX (Add'l Antibody) 88341_310 CDM 310 RC 88341 HCPCS facility both TC 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 88342 AP Bill Surg IPX (First Antibody) 88342 CDM 971 RC 88342 HCPCS facility both 26 29 29 Gross Charge Type: NIHD_Hosp_Tech_Price 88342 AP Bill Surg IPX (First Antibody) 88342 CDM 971 RC 88342 HCPCS facility both 26 29 29 Gross Charge Type: NIHD_Hosp_Tech_Price 88342 AP Bill Surg IPX (First Antibody) 88342 CDM 971 RC 88342 HCPCS facility both 26 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 88342 AP Bill Surg IPX (First Antibody) 88342 CDM 971 RC 88342 HCPCS facility both 26 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 88342 AP Bill Surg IPX (First Antibody) 88342_310 CDM 310 RC 88342 HCPCS facility both TC 29 29 Gross Charge Type: NIHD_Hosp_Tech_Price 88342 AP Bill Surg IPX (First Antibody) 88342_310 CDM 310 RC 88342 HCPCS facility both TC 29 29 Gross Charge Type: NIHD_Hosp_Tech_Price 88342 AP Bill Surg IPX (First Antibody) 88342_310 CDM 310 RC 88342 HCPCS facility both TC 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 88342 AP Bill Surg IPX (First Antibody) 88342_310 CDM 310 RC 88342 HCPCS facility both TC 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.5 X 35MM 8835140 CDM 278 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORTICAL 3.5 X 35MM 8835140 CDM 278 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Bed Hold 8848692 CDM 760 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Bed Hold 8848692 CDM 760 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price Transcutaneous Bilirubin POC 887201 CDM 301 RC 88720 HCPCS facility both 51 51 Gross Charge Type: NIHD_RHC_Price Transcutaneous Bilirubin POC 887201 CDM 301 RC 88720 HCPCS facility both 51 51 Gross Charge Type: NIHD_Clinic_Price Transcutaneous Bilirubin POC 887201 CDM 301 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Transcutaneous Bilirubin POC 887201 CDM 301 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Bilirubin POC 887202 CDM 88720 HCPCS facility both 51 51 Gross Charge Type: NIHD_Clinic_Price Bilirubin POC 887202 CDM 301 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Bilirubin POC 887202 CDM 301 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price OB EPIDURAL FACILITY CHARGE 8880833 CDM 720 RC facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price OB EPIDURAL FACILITY CHARGE 8880833 CDM 720 RC facility both 812 812 Gross Charge Type: NIHD_Hosp_Profee_Price CT E Z EM E Z GRID 8888004 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price CT E Z EM E Z GRID 8888004 CDM facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price Hearing Screen Clinic POC (RE) 8895778 CDM 521 RC facility both 73 73 Gross Charge Type: NIHD_RHC_Price Hearing Screen Clinic POC (RE) 8895778 CDM 521 RC facility both 73 73 Gross Charge Type: NIHD_Clinic_Price BF Cell Count w/Diff 890501 CDM 309 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price BF Cell Count w/Diff 890501 CDM 309 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price CSF Cell Count w/Diff 890502 CDM 309 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price CSF Cell Count w/Diff 890502 CDM 309 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price Crystal Examination Body Fluid 89060 CDM 971 RC 89060 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Tech_Price Crystal Examination Body Fluid 89060 CDM 971 RC 89060 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Tech_Price Crystal Examination Body Fluid 89060 CDM 971 RC 89060 HCPCS facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price Crystal Examination Body Fluid 89060 CDM 971 RC 89060 HCPCS facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price Crystal Examination Body Fluid 89060_309 CDM 309 RC 89060 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Tech_Price Crystal Examination Body Fluid 89060_309 CDM 309 RC 89060 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Tech_Price Crystal Examination Body Fluid 89060_309 CDM 309 RC 89060 HCPCS facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price Crystal Examination Body Fluid 89060_309 CDM 309 RC 89060 HCPCS facility both 28 28 Gross Charge Type: NIHD_Hosp_Profee_Price Semen Analysis 89321 CDM 309 RC facility both TC 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Semen Analysis 89321 CDM 309 RC facility both TC 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price "VAL KREULOCK SCREW, TI 3.0X18" 8933018 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "VAL KREULOCK SCREW, TI 3.0X18" 8933018 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "VAL KREULOCK SCREW, TI 3.0X22" 8933022 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "VAL KREULOCK SCREW, TI 3.0X22" 8933022 CDM 278 RC facility both 885 885 Gross Charge Type: NIHD_Hosp_Profee_Price "PHALANGEAL REAMER, 18MM" 8944018 CDM 272 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price "PHALANGEAL REAMER, 18MM" 8944018 CDM 272 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price "METATSRSAL REAMER, 18MM" 8944180 CDM 272 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price "METATSRSAL REAMER, 18MM" 8944180 CDM 272 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price "DRILL BIT, 2.0MM (AO)" 8944220 CDM 272 RC facility both 255 255 Gross Charge Type: NIHD_Hosp_Profee_Price "DRILL BIT, 2.0MM (AO)" 8944220 CDM 272 RC facility both 255 255 Gross Charge Type: NIHD_Hosp_Profee_Price "Xtrasorb Superabsorbent Wound Dressing, Sterile, 4"" x 5""" 8954500 CDM 272 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price "Xtrasorb Superabsorbent Wound Dressing, Sterile, 4"" x 5""" 8954500 CDM 272 RC facility both 15 15 Gross Charge Type: NIHD_Hosp_Profee_Price "GDWIRE W/TRCR TIP .078""x8"" (2MM x 200MM)" 8956010 CDM 272 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price "GDWIRE W/TRCR TIP .078""x8"" (2MM x 200MM)" 8956010 CDM 272 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price "DRILL, CANNULATED, 3.5MM" 8956350 CDM 272 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "DRILL, CANNULATED, 3.5MM" 8956350 CDM 272 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price Cataract Extraction with IOL 8957903 CDM 360 RC facility both 6058 6058 Gross Charge Type: NIHD_Hosp_Profee_Price Cataract Extraction with IOL 8957903 CDM 360 RC facility both 6058 6058 Gross Charge Type: NIHD_Hosp_Profee_Price "Histamine Determination, Plasma LC" 8979859 CDM 301 RC facility both 8.55 8.55 Gross Charge Type: NIHD_Hosp_Profee_Price "Histamine Determination, Plasma LC" 8979859 CDM 301 RC facility both 8.55 8.55 Gross Charge Type: NIHD_Hosp_Profee_Price Myoglobin LC 8980674 CDM 301 RC facility both 109.25 109.25 Gross Charge Type: NIHD_Hosp_Profee_Price Myoglobin LC 8980674 CDM 301 RC facility both 109.25 109.25 Gross Charge Type: NIHD_Hosp_Profee_Price Mercury LC 8980691 CDM 301 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price Mercury LC 8980691 CDM 301 RC facility both 15.48 15.48 Gross Charge Type: NIHD_Hosp_Profee_Price "PE+Interp(Rfx IFE),S LC" 8980710 CDM 301 RC facility both 3.98 3.98 Gross Charge Type: NIHD_Hosp_Profee_Price "PE+Interp(Rfx IFE),S LC" 8980710 CDM 301 RC facility both 3.98 3.98 Gross Charge Type: NIHD_Hosp_Profee_Price "PE (Rfx IFE+FLC), S LC" 8980711 CDM 301 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price "PE (Rfx IFE+FLC), S LC" 8980711 CDM 301 RC facility both 8 8 Gross Charge Type: NIHD_Hosp_Profee_Price Macroprolactin LC 8980738 CDM 301 RC facility both 36.24 36.24 Gross Charge Type: NIHD_Hosp_Profee_Price Macroprolactin LC 8980738 CDM 301 RC facility both 36.24 36.24 Gross Charge Type: NIHD_Hosp_Profee_Price Testosterone Free MS/Dialysis LC 8980740 CDM 301 RC facility both 47.5 47.5 Gross Charge Type: NIHD_Hosp_Profee_Price Testosterone Free MS/Dialysis LC 8980740 CDM 301 RC facility both 47.5 47.5 Gross Charge Type: NIHD_Hosp_Profee_Price "pH, Stool LC" 8980770 CDM 301 RC facility both 2.59 2.59 Gross Charge Type: NIHD_Hosp_Profee_Price "pH, Stool LC" 8980770 CDM 301 RC facility both 2.59 2.59 Gross Charge Type: NIHD_Hosp_Profee_Price Arsenic LC 8980781 CDM 301 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price Arsenic LC 8980781 CDM 301 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price "Infliximab and Anti-Infliximab Antibody (Serial Monitor), DoseASSURE™ IFX LC" 9002564 CDM 301 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price "Infliximab and Anti-Infliximab Antibody (Serial Monitor), DoseASSURE™ IFX LC" 9002564 CDM 301 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price "90380 Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscu" 90380 CDM 636 RC 90380 HCPCS facility both 655 655 Gross Charge Type: NIHD_RHC_Price "90380 Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscu" 90380 CDM 636 RC 90380 HCPCS facility both 686 686 Gross Charge Type: NIHD_Clinic_Price "90380 VFC Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intram" 903801 CDM 636 RC 90380 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90380 VFC Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intram" 903801 CDM 636 RC 90380 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90381 Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscula" 90381 CDM 636 RC 90381 HCPCS facility both 655 655 Gross Charge Type: NIHD_RHC_Price "90381 Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscula" 90381 CDM 636 RC 90381 HCPCS facility both 686 686 Gross Charge Type: NIHD_Clinic_Price "90381 VFC Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramus" 903811 CDM 636 RC 90381 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90381 VFC Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramus" 903811 CDM 636 RC 90381 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90384 Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)" 90384 CDM 636 RC 90384 HCPCS facility both 146 146 Gross Charge Type: NIHD_RHC_Price "90384 Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)" 90384 CDM 636 RC 90384 HCPCS facility both 146 146 Gross Charge Type: NIHD_Clinic_Price "LO-PRO SCRW, PT THD, TI, 4.5MMX40MM" 9045400 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price "LO-PRO SCRW, PT THD, TI, 4.5MMX40MM" 9045400 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price "90460 Immunization counseling and administration, through 18 yrs; first or only component" 90460 CDM 771 RC 90460 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price "90460 Immunization counseling and administration, through 18 yrs; first or only component" 90460 CDM 771 RC 90460 HCPCS facility both 96 96 Gross Charge Type: NIHD_Clinic_Price "90460 VFC Immunization counseling and administration, through 18 yrs; first or only component" 904601 CDM 771 RC 90460 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price "90460 VFC Immunization counseling and administration, through 18 yrs; first or only component" 904601 CDM 771 RC 90460 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price "90461 Immunization counseling and administration, through 18 yrs; each additional vaccine component" 90461 CDM 771 RC 90461 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price "90461 Immunization counseling and administration, through 18 yrs; each additional vaccine component" 90461 CDM 771 RC 90461 HCPCS facility both 101 101 Gross Charge Type: NIHD_Clinic_Price "90461 VFC Immunization counseling and administration, through 18 yrs; each additional vaccine compo" 904611 CDM 771 RC 90461 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price "90461 VFC Immunization counseling and administration, through 18 yrs; each additional vaccine compo" 904611 CDM 771 RC 90461 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price 90471 VFC Immunization administration; first vaccine 90471 CDM 771 RC 90471 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price 90471 VFC Immunization administration; first vaccine 90471 CDM 771 RC 90471 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price 90471 Immunization administration: first vaccine 904711 CDM 771 RC 90471 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price 90471 Immunization administration: first vaccine 904711 CDM 771 RC 90471 HCPCS facility both 101 101 Gross Charge Type: NIHD_Clinic_Price 90471  IM ADM PRQ ID SUBQ IM NJXS 1 VACCINE TechFee 904712 CDM 771 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 90471-Vaccine Administration 904712 CDM 771 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 90471 IMMUNIZATION ADMIN 1 VAC Charge 904713 CDM 761 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 90471 IMMUNIZATION ADMIN 1 VAC Charge 904713 CDM 761 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 90471 SQ/IM IMMUNIZATION CHARGE 904714 CDM 771 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 90471 SQ/IM IMMUNIZATION CHARGE 904714 CDM 771 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 90472  IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee 90472 CDM 450 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 90472  IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee 90472 CDM 450 RC facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 90472 Immunization administration; each additional vaccine 904721 CDM 771 RC 90472 HCPCS facility both 38 38 Gross Charge Type: NIHD_RHC_Price 90472 Immunization administration; each additional vaccine 904721 CDM 771 RC 90472 HCPCS facility both 40 40 Gross Charge Type: NIHD_Clinic_Price 90472 VFC Immunization administration; each additional vaccine 904722 CDM 771 RC 90472 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price 90472 VFC Immunization administration; each additional vaccine 904722 CDM 771 RC 90472 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price 90473 Immunization administration by intranasal or oral route; first vaccine 90473 CDM 771 RC 90473 HCPCS facility both 36 36 Gross Charge Type: NIHD_RHC_Price 90473 Immunization administration by intranasal or oral route; first vaccine 90473 CDM 771 RC 90473 HCPCS facility both 41 41 Gross Charge Type: NIHD_Clinic_Price "90474 Each additional vaccine by intranasal or oral route, 2-49 years of age" 90474 CDM 771 RC 90474 HCPCS facility both 40 40 Gross Charge Type: NIHD_RHC_Price "90474 Each additional vaccine by intranasal or oral route, 2-49 years of age" 90474 CDM 771 RC 90474 HCPCS facility both 41 41 Gross Charge Type: NIHD_Clinic_Price 90480 Immunization administration by intramuscular injection of severe respiratory syndrome coronavi 90480 CDM 771 RC 90480 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price 90480 Immunization administration by intramuscular injection of severe respiratory syndrome coronavi 90480 CDM 771 RC 90480 HCPCS facility both 101 101 Gross Charge Type: NIHD_Clinic_Price 90480 VFC Covid-19 Vaccine Adminsitration 904801 CDM 771 RC 90480 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price 90480 VFC Covid-19 Vaccine Adminsitration 904801 CDM 771 RC 90480 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price CT IAC w/ + w/o Contrast - Report 904811 CDM 972 RC 70481 HCPCS facility both 26 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price CT IAC w/ + w/o Contrast - Report 904811 CDM 972 RC 70481 HCPCS facility both 26 780 780 Gross Charge Type: NIHD_Hosp_Profee_Price "90620 Meningococcal vaccine, Serogroup B, 2 dose schedule, for IM use" 906201 CDM 636 RC 90620 HCPCS facility both 185 185 Gross Charge Type: NIHD_RHC_Price "90620 Meningococcal vaccine, Serogroup B, 2 dose schedule, for IM use" 906201 CDM 636 RC 90620 HCPCS facility both 195 195 Gross Charge Type: NIHD_Clinic_Price "90620 VFC Meningococcal vaccine, Serogroup B, 2 dose schedule, for IM use" 906202 CDM 636 RC 90620 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90620 VFC Meningococcal vaccine, Serogroup B, 2 dose schedule, for IM use" 906202 CDM 636 RC 90620 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal" 906301 CDM 636 RC 90630 HCPCS facility both 45 45 Gross Charge Type: NIHD_RHC_Price "90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal" 906301 CDM 636 RC 90630 HCPCS facility both 47 47 Gross Charge Type: NIHD_Clinic_Price "90630 VFC Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intrader" 906302 CDM 636 RC 90630 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90630 VFC Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intrader" 906302 CDM 636 RC 90630 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90632 Hepatitis A vaccine, adult dosage, for intramuscular use" 90632 CDM 636 RC 90632 HCPCS facility both 227 227 Gross Charge Type: NIHD_RHC_Price "90632 Hepatitis A vaccine, adult dosage, for intramuscular use" 90632 CDM 636 RC 90632 HCPCS facility both 238 238 Gross Charge Type: NIHD_Clinic_Price "90632 VFC Hepatitis A vaccine, adult dosage, for intramuscular use" 906322 CDM 636 RC 90632 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90632 VFC Hepatitis A vaccine, adult dosage, for intramuscular use" 906322 CDM 636 RC 90632 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90633 Havrix Hepatitis A vaccine, 2 dose schedule, for intramuscular use" 906331 CDM 636 RC 90633 HCPCS facility both 101 101 Gross Charge Type: NIHD_RHC_Price "90633 Havrix Hepatitis A vaccine, 2 dose schedule, for intramuscular use" 906331 CDM 636 RC 90633 HCPCS facility both 103 103 Gross Charge Type: NIHD_Clinic_Price "90633 VFC Havrix Hepatitis A vaccine, 2 dose schedule, for intramuscular use" 906332 CDM 636 RC 90633 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90633 VFC Havrix Hepatitis A vaccine, 2 dose schedule, for intramuscular use" 906332 CDM 636 RC 90633 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90647 Hib vaccine, PRP-OMP conjugate" 906471 CDM 636 RC 90647 HCPCS facility both 86 86 Gross Charge Type: NIHD_RHC_Price "90647 Hib vaccine, PRP-OMP conjugate" 906471 CDM 636 RC 90647 HCPCS facility both 88 88 Gross Charge Type: NIHD_Clinic_Price "90647 VFC Hib vaccine, PRP-OMP conjugate" 906472 CDM 636 RC 90647 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90647 VFC Hib vaccine, PRP-OMP conjugate" 906472 CDM 636 RC 90647 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90648 Hib PRP-T Conjugate 4 dose schedule IM. 90648 CDM 636 RC 90648 HCPCS facility both 80 80 Gross Charge Type: NIHD_RHC_Price 90648 Hib PRP-T Conjugate 4 dose schedule IM. 90648 CDM 636 RC 90648 HCPCS facility both 78 78 Gross Charge Type: NIHD_Clinic_Price 90648 VFC Hib PRP-T Conjugate 4 dose schedule IM. 906482 CDM 636 RC 90648 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90648 VFC Hib PRP-T Conjugate 4 dose schedule IM. 906482 CDM 636 RC 90648 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90649 HPV vaccine, quadrivalent, over 18" 906491 CDM 636 RC 90649 HCPCS facility both 379 379 Gross Charge Type: NIHD_RHC_Price "90649 HPV vaccine, quadrivalent, over 18" 906491 CDM 636 RC 90649 HCPCS facility both 385 385 Gross Charge Type: NIHD_Clinic_Price "90649 VFC HPV vaccine, quadrivalent, over 18" 906492 CDM 636 RC 90649 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90649 VFC HPV vaccine, quadrivalent, over 18" 906492 CDM 636 RC 90649 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90651 VFC Vaccine- Gardasil 9 906511 CDM 636 RC 90651 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90651 VFC Vaccine- Gardasil 9 906511 CDM 636 RC 90651 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90651 Vaccine- Gardasil 9 906512 CDM 636 RC 90651 HCPCS facility both 265 265 Gross Charge Type: NIHD_RHC_Price 90651 Vaccine- Gardasil 9 906512 CDM 636 RC 90651 HCPCS facility both 278 278 Gross Charge Type: NIHD_Clinic_Price "90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use" 90653 CDM 636 RC 90653 HCPCS facility both 88 88 Gross Charge Type: NIHD_RHC_Price "90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use" 90653 CDM 636 RC 90653 HCPCS facility both 92 92 Gross Charge Type: NIHD_Clinic_Price "90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for" 906551 CDM 636 RC 90655 HCPCS facility both 44 44 Gross Charge Type: NIHD_RHC_Price "90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for" 906551 CDM 636 RC 90655 HCPCS facility both 47 47 Gross Charge Type: NIHD_Clinic_Price "90655 VFC Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage," 906552 CDM 636 RC 90655 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90655 VFC Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage," 906552 CDM 636 RC 90655 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90656 Influenza virus vaccine, trivalent, split virus, over 18" 90656 CDM 636 RC 90656 HCPCS facility both 54 54 Gross Charge Type: NIHD_RHC_Price "90656 Influenza virus vaccine, trivalent, split virus, over 18" 90656 CDM 636 RC 90656 HCPCS facility both 56 56 Gross Charge Type: NIHD_Clinic_Price 90657 Influenza Virus Vaccine Trivalent (IIV3) Split IM.25ml 906571 CDM 636 RC 90657 HCPCS facility both 61 61 Gross Charge Type: NIHD_RHC_Price 90657 Influenza Virus Vaccine Trivalent (IIV3) Split IM.25ml 906571 CDM 636 RC 90657 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price 90657 VFC Influenza Virus Vaccine Trivalent (IIV3) 906572 CDM 636 RC 90657 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90657 VFC Influenza Virus Vaccine Trivalent (IIV3) 906572 CDM 636 RC 90657 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90658 Influenza virus vaccine, trivalent, split virus, 3 yrs of age and older, for intramuscular use" 906581 CDM 636 RC 90658 HCPCS facility both 47 47 Gross Charge Type: NIHD_RHC_Price "90658 Influenza virus vaccine, trivalent, split virus, 3 yrs of age and older, for intramuscular use" 906581 CDM 636 RC 90658 HCPCS facility both 47 47 Gross Charge Type: NIHD_Clinic_Price "90658 VFC Influenza virus vaccine, trivalent, split virus, 3 yrs of age and older, for intramuscular" 906582 CDM 636 RC 90658 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90658 VFC Influenza virus vaccine, trivalent, split virus, 3 yrs of age and older, for intramuscular" 906582 CDM 636 RC 90658 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90660 Influenza Virus Vaccine Trivalent Live (LAIV3) Intranasal 90660 CDM 636 RC 90660 HCPCS facility both 1432 1432 Gross Charge Type: NIHD_RHC_Price 90660 Influenza Virus Vaccine Trivalent Live (LAIV3) Intranasal 90660 CDM 636 RC 90660 HCPCS facility both 1500 1500 Gross Charge Type: NIHD_Clinic_Price EZ IO-EZ STABILIZER 9066005 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price EZ IO-EZ STABILIZER 9066005 CDM facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative" 906611 CDM 636 RC 90661 HCPCS facility both 32 32 Gross Charge Type: NIHD_RHC_Price "90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative" 906611 CDM 636 RC 90661 HCPCS facility both 35 35 Gross Charge Type: NIHD_Clinic_Price "90661 VFC Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preserva" 906612 CDM 636 RC 90661 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90661 VFC Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preserva" 906612 CDM 636 RC 90661 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90662 Influenza virus vaccine, split virus, preservative free, for intramuscular use" 906621 CDM 636 RC 90662 HCPCS facility both 52 52 Gross Charge Type: NIHD_RHC_Price "90662 Influenza virus vaccine, split virus, preservative free, for intramuscular use" 906621 CDM 636 RC 90662 HCPCS facility both 54 54 Gross Charge Type: NIHD_Clinic_Price "90662 VFC Influenza virus vaccine, split virus, preservative free, for intramuscular use" 906622 CDM 636 RC 90662 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90662 VFC Influenza virus vaccine, split virus, preservative free, for intramuscular use" 906622 CDM 636 RC 90662 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price C-Telopeptide (Endocrine Sciences) LC 9066580 CDM 300 RC facility both 56.61 56.61 Gross Charge Type: NIHD_Hosp_Profee_Price C-Telopeptide (Endocrine Sciences) LC 9066580 CDM 300 RC facility both 56.61 56.61 Gross Charge Type: NIHD_Hosp_Profee_Price 90670 Pneumococcal 13-valent conjugate vaccine 906701 CDM 636 RC 90670 HCPCS facility both 203 203 Gross Charge Type: NIHD_RHC_Price 90670 Pneumococcal 13-valent conjugate vaccine 906701 CDM 636 RC 90670 HCPCS facility both 204 204 Gross Charge Type: NIHD_Clinic_Price 90670 VFC pneumococcal 13-valent conjugate vaccine 906702 CDM 636 RC 90670 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90670 VFC pneumococcal 13-valent conjugate vaccine 906702 CDM 636 RC 90670 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90672 Influenza virus vaccine, quadrivalent, live, for intranasal use" 906721 CDM 636 RC 90672 HCPCS facility both 44 44 Gross Charge Type: NIHD_RHC_Price "90672 Influenza virus vaccine, quadrivalent, live, for intranasal use" 906721 CDM 636 RC 90672 HCPCS facility both 46 46 Gross Charge Type: NIHD_Clinic_Price "90672 VFC Influenza virus vaccine, quadrivalent, live, for intranasal use" 906722 CDM 636 RC 90672 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90672 VFC Influenza virus vaccine, quadrivalent, live, for intranasal use" 906722 CDM 636 RC 90672 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90674 Influenza Virus Vaccine Quadrivalent (ccIV4) 906741 CDM 636 RC 90674 HCPCS facility both 47 47 Gross Charge Type: NIHD_RHC_Price 90674 Influenza Virus Vaccine Quadrivalent (ccIV4) 906741 CDM 636 RC 90674 HCPCS facility both 49 49 Gross Charge Type: NIHD_Clinic_Price 90674 VFC Influenza Virus Vaccine Quadrivalent (ccIV4) 906742 CDM 636 RC 90674 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90674 VFC Influenza Virus Vaccine Quadrivalent (ccIV4) 906742 CDM 636 RC 90674 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90675 Rabies vaccine, for intramuscular use" 906751 CDM 636 RC 90675 HCPCS facility both 453 453 Gross Charge Type: NIHD_RHC_Price "90675 Rabies vaccine, for intramuscular use" 906751 CDM 636 RC 90675 HCPCS facility both 476 476 Gross Charge Type: NIHD_Clinic_Price "90675 Rabies vaccine, for intramuscular use" 906751 CDM 636 RC 90675 HCPCS facility both 1325 1325 Gross Charge Type: NIHD_Hosp_Profee_Price "90675 Rabies vaccine, for intramuscular use" 906751 CDM 636 RC 90675 HCPCS facility both 1325 1325 Gross Charge Type: NIHD_Hosp_Profee_Price "90675 VFC Rabies vaccine, for intramuscular use" 906752 CDM 636 RC 90675 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90675 VFC Rabies vaccine, for intramuscular use" 906752 CDM 636 RC 90675 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90675 Rabies vaccine, for intramuscular use" 906753 CDM 636 RC 90675 HCPCS facility both 1325 1325 Gross Charge Type: NIHD_Hosp_Profee_Price "90675 Rabies vaccine, for intramuscular use" 906753 CDM 636 RC 90675 HCPCS facility both 1325 1325 Gross Charge Type: NIHD_Hosp_Profee_Price Prevnar 20 vaccine IM 90677 CDM 636 RC 90677 HCPCS facility both 329 329 Gross Charge Type: NIHD_RHC_Price Prevnar 20 vaccine IM 90677 CDM 636 RC 90677 HCPCS facility both 345 345 Gross Charge Type: NIHD_Clinic_Price pneumococcal 20-valent conjugate vaccine [INYO] 90677 CDM 00005-2000-10 NDC facility both 0.5 ML 1791.89 1791.89 Gross Charge Type: Pharmacy 90677 VFC Pneumococcal 20-Valent (Prevnar 20) 906771 CDM 636 RC 90677 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90677 VFC Pneumococcal 20-Valent (Prevnar 20) 906771 CDM 636 RC 90677 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90677 VFC Pneumococcal 20-valent conjugate vaccine 906772 CDM 636 RC 90677 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90677 VFC Pneumococcal 20-valent conjugate vaccine 906772 CDM 636 RC 90677 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90678 Abrysvo 90678 CDM 636 RC 90678 HCPCS facility both 1062 1062 Gross Charge Type: NIHD_RHC_Price 90678 Abrysvo 90678 CDM 636 RC 90678 HCPCS facility both 1112 1112 Gross Charge Type: NIHD_Clinic_Price 90679 Abrysvo Adult RSV Vaccine 90679 CDM 636 RC 90679 HCPCS facility both 471 471 Gross Charge Type: NIHD_RHC_Price 90679 Abrysvo Adult RSV Vaccine 90679 CDM 636 RC 90679 HCPCS facility both 493 493 Gross Charge Type: NIHD_Clinic_Price "90680 Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use" 906801 CDM 636 RC 90680 HCPCS facility both 225 225 Gross Charge Type: NIHD_RHC_Price "90680 Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use" 906801 CDM 636 RC 90680 HCPCS facility both 229 229 Gross Charge Type: NIHD_Clinic_Price "90680 VFC Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use" 906802 CDM 636 RC 90680 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90680 VFC Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use" 906802 CDM 636 RC 90680 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90681 Rotavirus, monovalent RV1" 906811 CDM 636 RC 90681 HCPCS facility both 85 85 Gross Charge Type: NIHD_RHC_Price "90681 Rotavirus, monovalent RV1" 906811 CDM 636 RC 90681 HCPCS facility both 89 89 Gross Charge Type: NIHD_Clinic_Price "90681 VFC Rotavirus, monovalent RV1" 906812 CDM 636 RC 90681 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90681 VFC Rotavirus, monovalent RV1" 906812 CDM 636 RC 90681 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90685 Influenza virus vaccine, quadrivalent, split virus, pre free, 6-35 mo, for intramuscular use" 906851 CDM 636 RC 90685 HCPCS facility both 63 63 Gross Charge Type: NIHD_RHC_Price "90685 Influenza virus vaccine, quadrivalent, split virus, pre free, 6-35 mo, for intramuscular use" 906851 CDM 636 RC 90685 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price "90685 VFC Influenza virus vaccine, quadrivalent, split virus, pre free, 6-35 mo, for intramuscular u" 906852 CDM 636 RC 90685 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90685 VFC Influenza virus vaccine, quadrivalent, split virus, pre free, 6-35 mo, for intramuscular u" 906852 CDM 636 RC 90685 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage" 906861 CDM 636 RC 90686 HCPCS facility both 63 63 Gross Charge Type: NIHD_RHC_Price "90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage" 906861 CDM 636 RC 90686 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price "90686 VFC Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosag" 906862 CDM 636 RC 90686 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90686 VFC Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosag" 906862 CDM 636 RC 90686 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular u" 906871 CDM 636 RC 90687 HCPCS facility both 63 63 Gross Charge Type: NIHD_RHC_Price "90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular u" 906871 CDM 636 RC 90687 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price "90687 VFC Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscul" 906872 CDM 636 RC 90687 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90687 VFC Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscul" 906872 CDM 636 RC 90687 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage" 906881 CDM 636 RC 90688 HCPCS facility both 63 63 Gross Charge Type: NIHD_RHC_Price "90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage" 906881 CDM 636 RC 90688 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price "90688 VFC Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage" 906882 CDM 636 RC 90688 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90688 VFC Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage" 906882 CDM 636 RC 90688 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90691 Typhoid vaccine, over 18" 90691 CDM 636 RC 90691 HCPCS facility both 188 188 Gross Charge Type: NIHD_RHC_Price "90691 Typhoid vaccine, over 18" 90691 CDM 636 RC 90691 HCPCS facility both 197 197 Gross Charge Type: NIHD_Clinic_Price 90694 Fluad Quadrivalent High Dose 90694 CDM 636 RC 90694 HCPCS facility both 63 63 Gross Charge Type: NIHD_RHC_Price 90694 Fluad Quadrivalent High Dose 90694 CDM 636 RC 90694 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price "90696 DTaP-IPV, when administered to children 4 through 6 years of age, for intramuscular use" 906961 CDM 636 RC 90696 HCPCS facility both 143 143 Gross Charge Type: NIHD_RHC_Price "90696 DTaP-IPV, when administered to children 4 through 6 years of age, for intramuscular use" 906961 CDM 636 RC 90696 HCPCS facility both 146 146 Gross Charge Type: NIHD_Clinic_Price "90696 VFC DTaP-IPV, when administered to children 4 through 6 years of age, for intramuscular use" 906962 CDM 636 RC 90696 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90696 VFC DTaP-IPV, when administered to children 4 through 6 years of age, for intramuscular use" 906962 CDM 636 RC 90696 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90697 Vaxelis vaccine, for IM use" 90697 CDM 636 RC 90697 HCPCS facility both 184 184 Gross Charge Type: NIHD_RHC_Price "90697 Vaxelis vaccine, for IM use" 90697 CDM 636 RC 90697 HCPCS facility both 193 193 Gross Charge Type: NIHD_Clinic_Price 90697-VFC Vaxelis 906971 CDM 636 RC 90697 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90697-VFC Vaxelis 906971 CDM 636 RC 90697 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90700 DTaP, under 7 years, for IM use" 907001 CDM 636 RC 90700 HCPCS facility both 76 76 Gross Charge Type: NIHD_RHC_Price "90700 DTaP, under 7 years, for IM use" 907001 CDM 636 RC 90700 HCPCS facility both 74 74 Gross Charge Type: NIHD_Clinic_Price "90700 VFC DTaP, under 7 years, for IM use" 907002 CDM 636 RC 90700 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90700 VFC DTaP, under 7 years, for IM use" 907002 CDM 636 RC 90700 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use" 907071 CDM 636 RC 90707 HCPCS facility both 151 151 Gross Charge Type: NIHD_RHC_Price "90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use" 907071 CDM 636 RC 90707 HCPCS facility both 152 152 Gross Charge Type: NIHD_Clinic_Price "90707 VFC Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use" 907072 CDM 636 RC 90707 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90707 VFC Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use" 907072 CDM 636 RC 90707 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use" 907101 CDM 636 RC 90710 HCPCS facility both 399 399 Gross Charge Type: NIHD_RHC_Price "90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use" 907101 CDM 636 RC 90710 HCPCS facility both 403 403 Gross Charge Type: NIHD_Clinic_Price "90710 VFC Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use" 907102 CDM 636 RC 90710 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90710 VFC Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use" 907102 CDM 636 RC 90710 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90713 Poliovirus vaccine, inactivated (IPV)" 907131 CDM 636 RC 90713 HCPCS facility both 86 86 Gross Charge Type: NIHD_RHC_Price "90713 Poliovirus vaccine, inactivated (IPV)" 907131 CDM 636 RC 90713 HCPCS facility both 88 88 Gross Charge Type: NIHD_Clinic_Price "90713 VFC Poliovirus vaccine, inactivated (IPV)" 907132 CDM 636 RC 90713 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90713 VFC Poliovirus vaccine, inactivated (IPV)" 907132 CDM 636 RC 90713 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90714 Tenivac - Tetanus and diphtheria toxoids (Td), over 18" 907141 CDM 636 RC 90714 HCPCS facility both 25 25 Gross Charge Type: NIHD_RHC_Price "90714 Tenivac - Tetanus and diphtheria toxoids (Td), over 18" 907141 CDM 636 RC 90714 HCPCS facility both 26 26 Gross Charge Type: NIHD_Clinic_Price "90714 VFC Tenivac - Tetanus and diphtheria toxoids (Td), over 18" 907142 CDM 636 RC 90714 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90714 VFC Tenivac - Tetanus and diphtheria toxoids (Td), over 18" 907142 CDM 636 RC 90714 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90715 Tdap, when administered to individuals 7 years or older, for intramuscular use" 907151 CDM 636 RC 90715 HCPCS facility both 69 69 Gross Charge Type: NIHD_RHC_Price "90715 Tdap, when administered to individuals 7 years or older, for intramuscular use" 907151 CDM 636 RC 90715 HCPCS facility both 71 71 Gross Charge Type: NIHD_Clinic_Price "90715 VFC Tdap, when administered to individuals 7 years or older, for intramuscular use" 907152 CDM 636 RC 90715 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90715 VFC Tdap, when administered to individuals 7 years or older, for intramuscular use" 907152 CDM 636 RC 90715 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90716 VFC Varicella virus vaccine, live, for subcutaneous use" 907161 CDM 636 RC 90716 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90716 VFC Varicella virus vaccine, live, for subcutaneous use" 907161 CDM 636 RC 90716 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90716 Varicella virus vaccine, live, for subcutaneous use" 907162 CDM 636 RC 90716 HCPCS facility both 220 220 Gross Charge Type: NIHD_RHC_Price "90716 Varicella virus vaccine, live, for subcutaneous use" 907162 CDM 636 RC 90716 HCPCS facility both 222 222 Gross Charge Type: NIHD_Clinic_Price "90723 DTaP-HepB-IPV (Pediarix), for intramuscular use" 907231 CDM 636 RC 90723 HCPCS facility both 220 220 Gross Charge Type: NIHD_RHC_Price "90723 DTaP-HepB-IPV (Pediarix), for intramuscular use" 907231 CDM 636 RC 90723 HCPCS facility both 222 222 Gross Charge Type: NIHD_Clinic_Price "90723 VFC DTaP-HepB-IPV (Pediarix), for intramuscular use" 907232 CDM 636 RC 90723 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90723 VFC DTaP-HepB-IPV (Pediarix), for intramuscular use" 907232 CDM 636 RC 90723 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90732 Pneumococcal polysaccharide vaccine, 23-valent, for subcutaneous or intramuscular use" 907321 CDM 636 RC 90732 HCPCS facility both 115 115 Gross Charge Type: NIHD_RHC_Price "90732 Pneumococcal polysaccharide vaccine, 23-valent, for subcutaneous or intramuscular use" 907321 CDM 636 RC 90732 HCPCS facility both 117 117 Gross Charge Type: NIHD_Clinic_Price "90732 VFC Pneumococcal polysaccharide vaccine, 23-valent, for subcutaneous or intramuscular use" 907322 CDM 636 RC 90732 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90732 VFC Pneumococcal polysaccharide vaccine, 23-valent, for subcutaneous or intramuscular use" 907322 CDM 636 RC 90732 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90734 Meningococcal conjugate vaccine, quadrivalent, for intramuscular use" 907341 CDM 636 RC 90734 HCPCS facility both 285 285 Gross Charge Type: NIHD_RHC_Price "90734 Meningococcal conjugate vaccine, quadrivalent, for intramuscular use" 907341 CDM 636 RC 90734 HCPCS facility both 288 288 Gross Charge Type: NIHD_Clinic_Price "90734 VFC Meningococcal conjugate vaccine, quadrivalent, for intramuscular use" 907342 CDM 636 RC 90734 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90734 VFC Meningococcal conjugate vaccine, quadrivalent, for intramuscular use" 907342 CDM 636 RC 90734 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90736 Zoster (shingles) vaccine, live, for subcutaneous injection" 907361 CDM 636 RC 90736 HCPCS facility both 359 359 Gross Charge Type: NIHD_RHC_Price "90736 Zoster (shingles) vaccine, live, for subcutaneous injection" 907361 CDM 636 RC 90736 HCPCS facility both 365 365 Gross Charge Type: NIHD_Clinic_Price "90736 VFC Zoster (shingles) vaccine, live, for subcutaneous injection" 907362 CDM 636 RC 90736 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90736 VFC Zoster (shingles) vaccine, live, for subcutaneous injection" 907362 CDM 636 RC 90736 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "90739 Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use" 90739 CDM 636 RC 90739 HCPCS facility both 222 222 Gross Charge Type: NIHD_RHC_Price "90739 Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use" 90739 CDM 636 RC 90739 HCPCS facility both 234 234 Gross Charge Type: NIHD_Clinic_Price "90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use" 907441 CDM 636 RC 90744 HCPCS facility both 104 104 Gross Charge Type: NIHD_RHC_Price "90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use" 907441 CDM 636 RC 90744 HCPCS facility both 107 107 Gross Charge Type: NIHD_Clinic_Price "90744 VFC Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use" 907442 CDM 636 RC 90744 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90744 VFC Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use" 907442 CDM 636 RC 90744 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90746 Vaccine - Hepatitis B Adult Vaccine 90746 CDM 636 RC 90746 HCPCS facility both 217 217 Gross Charge Type: NIHD_RHC_Price 90746 Vaccine - Hepatitis B Adult Vaccine 90746 CDM 636 RC 90746 HCPCS facility both 228 228 Gross Charge Type: NIHD_Clinic_Price 90747 VFC Hepatitis B Vaccine Dialysis or Immunosuppressed 4 Dose IM 907472 CDM 636 RC 90747 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90747 VFC Hepatitis B Vaccine Dialysis or Immunosuppressed 4 Dose IM 907472 CDM 636 RC 90747 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90748 Hepatitis B and Haemophilus (Hib-HepB) 90748 CDM 636 RC 90748 HCPCS facility both 159 159 Gross Charge Type: NIHD_RHC_Price 90748 Hepatitis B and Haemophilus (Hib-HepB) 90748 CDM 636 RC 90748 HCPCS facility both 160 160 Gross Charge Type: NIHD_Clinic_Price 90748 VFC Hepatitis B and Haemophilus (Hib-HepB) 907482 CDM 636 RC 90748 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 90748 VFC Hepatitis B and Haemophilus (Hib-HepB) 907482 CDM 636 RC 90748 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90749 Unlisted vaccine/toxoid 907491 CDM 636 RC 90749 HCPCS facility both 191 191 Gross Charge Type: NIHD_RHC_Price 90749 Unlisted vaccine/toxoid 907491 CDM 636 RC 90749 HCPCS facility both 200 200 Gross Charge Type: NIHD_Clinic_Price "90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use" 90750 CDM 636 RC 90750 HCPCS facility both 275 275 Gross Charge Type: NIHD_RHC_Price "90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use" 90750 CDM 636 RC 90750 HCPCS facility both 288 288 Gross Charge Type: NIHD_Clinic_Price 90756 Flucelvax Quadrivalent 2020-2021 LHC 907561 CDM 636 RC 90756 HCPCS facility both 51 51 Gross Charge Type: NIHD_RHC_Price 90756 Flucelvax Quadrivalent 2020-2021 LHC 907561 CDM 636 RC 90756 HCPCS facility both 53 53 Gross Charge Type: NIHD_Clinic_Price "90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibioti" 907562 CDM 636 RC 90756 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibioti" 907562 CDM 636 RC 90756 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 90785 Interative Complexity Charge 90785 CDM 521 RC 90785 HCPCS facility both 23 23 Gross Charge Type: NIHD_RHC_Price 90785 Interative Complexity Charge 90785 CDM 521 RC 90785 HCPCS facility both 23 23 Gross Charge Type: NIHD_Clinic_Price 90791 Psychiatric diagnostic evaluation 90791 CDM 521 RC 90791 HCPCS facility both 250 250 Gross Charge Type: NIHD_RHC_Price 90791 Psychiatric diagnostic evaluation 90791 CDM 521 RC 90791 HCPCS facility both 250 250 Gross Charge Type: NIHD_Clinic_Price ROOM/BED: MedSurg 9079158 CDM 121 RC facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: MedSurg 9079158 CDM 121 RC facility both 3306 3306 Gross Charge Type: NIHD_Hosp_Profee_Price 90792 Psychiatric diagnostic evaluation with medical services 90792 CDM 521 RC 90792 HCPCS facility both 279 279 Gross Charge Type: NIHD_RHC_Price 90792 Psychiatric diagnostic evaluation with medical services 90792 CDM 521 RC 90792 HCPCS facility both 279 279 Gross Charge Type: NIHD_Clinic_Price "90832 Psychotherapy, 30 minutes with patient and/or family member" 90832 CDM 521 RC 90832 HCPCS facility both 114 114 Gross Charge Type: NIHD_RHC_Price "90832 Psychotherapy, 30 minutes with patient and/or family member" 90832 CDM 521 RC 90832 HCPCS facility both 114 114 Gross Charge Type: NIHD_Clinic_Price "90833 Psychotherapy, 30 minutes w/ patient and/or family member when performed w/ E & M service" 90833 CDM 521 RC 90833 HCPCS facility both 118 118 Gross Charge Type: NIHD_RHC_Price "90833 Psychotherapy, 30 minutes w/ patient and/or family member when performed w/ E & M service" 90833 CDM 521 RC 90833 HCPCS facility both 118 118 Gross Charge Type: NIHD_Clinic_Price "90834 Psychotherapy, 45 minutes with patient and/or family member" 90834 CDM 521 RC 90834 HCPCS facility both 152 152 Gross Charge Type: NIHD_RHC_Price "90834 Psychotherapy, 45 minutes with patient and/or family member" 90834 CDM 521 RC 90834 HCPCS facility both 152 152 Gross Charge Type: NIHD_Clinic_Price "90836 Psychotherapy, 45 minutes w/ patient and/or family member when performed w/ E & M service" 90836 CDM 521 RC 90836 HCPCS facility both 150 150 Gross Charge Type: NIHD_RHC_Price "90836 Psychotherapy, 45 minutes w/ patient and/or family member when performed w/ E & M service" 90836 CDM 521 RC 90836 HCPCS facility both 150 150 Gross Charge Type: NIHD_Clinic_Price "90837 Psychotherapy, 60 minutes with patient and/or family member" 90837 CDM 521 RC 90837 HCPCS facility both 244 244 Gross Charge Type: NIHD_RHC_Price "90837 Psychotherapy, 60 minutes with patient and/or family member" 90837 CDM 521 RC 90837 HCPCS facility both 244 244 Gross Charge Type: NIHD_Clinic_Price "90838 Psychotherapy, 60 minutes w/ patient and/or family member when performed w/ E & M service" 90838 CDM 521 RC 90838 HCPCS facility both 198 198 Gross Charge Type: NIHD_RHC_Price "90838 Psychotherapy, 60 minutes w/ patient and/or family member when performed w/ E & M service" 90838 CDM 521 RC 90838 HCPCS facility both 198 198 Gross Charge Type: NIHD_Clinic_Price 90839 Psychotherapy for crisis; first 60 minutes 90839 CDM 521 RC 90839 HCPCS facility both 326 326 Gross Charge Type: NIHD_RHC_Price 90839 Psychotherapy for crisis; first 60 minutes 90839 CDM 521 RC 90839 HCPCS facility both 326 326 Gross Charge Type: NIHD_Clinic_Price 90840 Psychotherapy for crisis; each additional 30 minutes 90840 CDM 521 RC 90840 HCPCS facility both 123 123 Gross Charge Type: NIHD_RHC_Price 90840 Psychotherapy for crisis; each additional 30 minutes 90840 CDM 521 RC 90840 HCPCS facility both 123 123 Gross Charge Type: NIHD_Clinic_Price 90845 Psychoanalysis Charge 90845 CDM 521 RC 90845 HCPCS facility both 163 163 Gross Charge Type: NIHD_RHC_Price 90845 Psychoanalysis Charge 90845 CDM 521 RC 90845 HCPCS facility both 163 163 Gross Charge Type: NIHD_Clinic_Price 90846 Family psychotherapy without the patient present 90846 CDM 521 RC 90846 HCPCS facility both 183 183 Gross Charge Type: NIHD_RHC_Price 90846 Family psychotherapy without the patient present 90846 CDM 521 RC 90846 HCPCS facility both 183 183 Gross Charge Type: NIHD_Clinic_Price "90847 Family psychotherapy, conjoint psychotherapy, with patient present" 90847 CDM 521 RC 90847 HCPCS facility both 191 191 Gross Charge Type: NIHD_RHC_Price "90847 Family psychotherapy, conjoint psychotherapy, with patient present" 90847 CDM 521 RC 90847 HCPCS facility both 191 191 Gross Charge Type: NIHD_Clinic_Price 90849 Multiple-family group psychotherapy 90849 CDM 521 RC 90849 HCPCS facility both 66 66 Gross Charge Type: NIHD_RHC_Price 90849 Multiple-family group psychotherapy 90849 CDM 521 RC 90849 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price 90853 Group psychotherapy (other than of a multiple-family group) 90853 CDM 521 RC 90853 HCPCS facility both 46 46 Gross Charge Type: NIHD_RHC_Price 90853 Group psychotherapy (other than of a multiple-family group) 90853 CDM 521 RC 90853 HCPCS facility both 46 46 Gross Charge Type: NIHD_Clinic_Price 90863 Pharmacologic Management Charge 90863 CDM 521 RC 90863 HCPCS facility both 47 47 Gross Charge Type: NIHD_RHC_Price 90863 Pharmacologic Management Charge 90863 CDM 521 RC 90863 HCPCS facility both 47 47 Gross Charge Type: NIHD_Clinic_Price "90863 Pharmacologic management, including prescription and review of medication, when performed with" 908631 CDM 521 RC 90863 HCPCS facility both 47 47 Gross Charge Type: NIHD_RHC_Price "90863 Pharmacologic management, including prescription and review of medication, when performed with" 908631 CDM 521 RC 90863 HCPCS facility both 47 47 Gross Charge Type: NIHD_Clinic_Price 90885 Psychiatric evaluation of records for medical diagnostic purposes 90885 CDM 900 RC 90885 HCPCS facility both 73 73 Gross Charge Type: NIHD_RHC_Price 90885 Psychiatric evaluation of records for medical diagnostic purposes 90885 CDM 900 RC 90885 HCPCS facility both 73 73 Gross Charge Type: NIHD_Clinic_Price 90899 Unlisted psychiatric service or procedure 90899 CDM 521 RC 90899 HCPCS facility both 40 40 Gross Charge Type: NIHD_RHC_Price 90899 Unlisted psychiatric service or procedure 90899 CDM 521 RC 90899 HCPCS facility both 40 40 Gross Charge Type: NIHD_Clinic_Price "Nicotine/Cotinine, Screen & Confirmation, Urine LC" 9092502 CDM 300 RC facility both 7.81 7.81 Gross Charge Type: NIHD_Hosp_Profee_Price "Nicotine/Cotinine, Screen & Confirmation, Urine LC" 9092502 CDM 300 RC facility both 7.81 7.81 Gross Charge Type: NIHD_Hosp_Profee_Price Bivalent 6m+ 25mcg/ml Booster – Dark Blue Cap 91314 CDM 636 RC 91314 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_RHC_Price Bivalent 6m+ 25mcg/ml Booster – Dark Blue Cap 91314 CDM 636 RC 91314 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 91321 Moderna SARSCOV2 vaccine 25 mcg/.25ml im 91321 CDM 636 RC 91321 HCPCS facility both 170 170 Gross Charge Type: NIHD_RHC_Price 91321 Moderna SARSCOV2 vaccine 25 mcg/.25ml im 91321 CDM 636 RC 91321 HCPCS facility both 178 178 Gross Charge Type: NIHD_Clinic_Price 91321 VFC Moderna SARSCOV2 vaccine 25 mcg/.25ml im 913211 CDM 636 RC 91321 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 91321 VFC Moderna SARSCOV2 vaccine 25 mcg/.25ml im 913211 CDM 636 RC 91321 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price 91322 Moderna 12+ Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 91322 CDM 91322 HCPCS facility both 172 172 Gross Charge Type: NIHD_RHC_Price 91322 Moderna 12+ Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 91322 CDM 91322 HCPCS facility both 180 180 Gross Charge Type: NIHD_Clinic_Price 91322 VFC SARSCOV2 SPIKEVAX 2023-2024 formula 12+yrs 913221 CDM 636 RC 91322 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_RHC_Price 91322 VFC SARSCOV2 SPIKEVAX 2023-2024 formula 12+yrs 913221 CDM 636 RC 91322 HCPCS facility both SL 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price lithium 300 mg Cap [INYO] 92008 CDM 00054-8527-25 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP amoxicillin 500 mg Cap [INYO] 92009 CDM 00781-2613-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP thiamine 100 mg/mL Sol [inyo] 92015 CDM J3411 HCPCS 00641-6228-25 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy thiamine 200 mg/2 mL Inj Sol [INYO] 92015 CDM J3411 HCPCS 63323-0013-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy thiamine 200 mg/2 mL Inj Sol [INYO] 92015 CDM J3411 HCPCS 25021-0500-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy thiamine 200 mg/2 mL Inj Sol [INYO] 92015 CDM J3411 HCPCS 67457-0196-02 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 1000 mL [INYO] 92016 CDM J7040 HCPCS 00338-0049-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% Sol 1000 mL [INYO] 92016 CDM J7040 HCPCS 00990-7983-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 1000 mL [INYO] 92016 CDM J7040 HCPCS 00264-7800-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 1000 mL [INYO] 92016 CDM J7040 HCPCS 63323-0623-76 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy SARS-CoV-2 (COVID-19) Antigen (Binax) 9202840 CDM 301 RC 87811 HCPCS facility both 82 82 Gross Charge Type: NIHD_RHC_Price SARS-CoV-2 (COVID-19) Antigen (Binax) 9202840 CDM 301 RC 87811 HCPCS facility both 82 82 Gross Charge Type: NIHD_Clinic_Price SARS-CoV-2 (COVID-19) Antigen (Binax) 9202840 CDM 301 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-CoV-2 (COVID-19) Antigen (Binax) 9202840 CDM 301 RC facility both 82 82 Gross Charge Type: NIHD_Hosp_Profee_Price clarithromycin 500 mg Tab [INYO] 92030 CDM 00904-6872-04 NDC facility both 1 EA 23.39 23.39 Gross Charge Type: Pharmacy | NDC EA = 1 TAB clarithromycin 500 mg Tab 92030 CDM 00781-1962-60 NDC facility both 1 EA 36.09 36.09 Gross Charge Type: Pharmacy | NDC EA = 1 TAB clarithromycin 500 mg Tab [INYO] 92030 CDM 68084-0651-25 NDC facility both 1 EA 36.81 36.81 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "Penicillin G Potassium 5,000,000 units Pow [INYO]" 92036 CDM J2540 HCPCS 00049-0520-83 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy erythromycin lactobionate 500 mg Inj [INYO] 92042 CDM J1364 HCPCS 00409-6482-01 NDC facility both 1 EA 785.32 785.32 Gross Charge Type: Pharmacy erythromycin lactobionate 500 mg Inj [INYO] 92042 CDM J1364 HCPCS 00409-6476-44 NDC facility both 1 EA 799.51 799.51 Gross Charge Type: Pharmacy cefTRIAXone 250 mg Inj [INYO] 92047 CDM J0696 HCPCS 60505-6151-01 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTRIAXone 250 mg Inj [INYO] 92047 CDM J0696 HCPCS 00781-3206-95 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTRIAXone 250 mg Inj [INYO] 92047 CDM J0696 HCPCS 00409-7337-01 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy morphine 10 mg/5 mL Oral Sol [INYO] 92075 CDM 00121-0904-94 NDC facility both 5 ML 35 35 Gross Charge Type: Pharmacy morphine 10 mg/5 mL Oral Sol [INYO] 92075 CDM 00054-0237-55 NDC facility both 5 ML 35 35 Gross Charge Type: Pharmacy morphine 10 mg/5 mL Oral Sol [INYO] 92075 CDM 68094-0001-62 NDC facility both 5 ML 35 35 Gross Charge Type: Pharmacy nitroglycerin 0.4 mg sublingual Tab [INYO] 92076 CDM 59762-3304-03 NDC facility both 1 EA 6.16 6.16 Gross Charge Type: Pharmacy | NDC EA = 1 TAB nitroglycerin 0.4 mg sublingual Tab [INYO] 92076 CDM 00071-0418-13 NDC facility both 1 EA 9.41 9.41 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited exa" 92081 CDM 521 RC 92081 HCPCS facility both 106 106 Gross Charge Type: NIHD_RHC_Price "92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited exa" 92081 CDM 521 RC 92081 HCPCS facility both 106 106 Gross Charge Type: NIHD_Clinic_Price flecainide 100 mg Tab [INYO] 92081 CDM 50268-0321-15 NDC facility both 1 EA 35.85 35.85 Gross Charge Type: Pharmacy | NDC EA = 1 TAB flecainide 100 mg Tab [INYO] 92081 CDM 00054-0011-20 NDC facility both 1 EA 21.48 21.48 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ciprofloxacin 500 mg Tab [inyo] 92092 CDM 68084-0070-01 NDC facility both 1 EA 19.06 19.06 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ciprofloxacin 500 mg Tab [INYO] 92092 CDM 00904-6378-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ciprofloxacin 500 mg Tab [INYO] 92092 CDM 00904-7083-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ciprofloxacin 500 mg Tab [INYO] 92092 CDM 00143-9928-01 NDC facility both 1 EA 32.21 32.21 Gross Charge Type: Pharmacy | NDC EA = 1 TAB 92250 Fundus photography with interpretation and report 92250 CDM 521 RC 92250 HCPCS facility both 109 109 Gross Charge Type: NIHD_RHC_Price 92507 TREATMENT OF SPEECH/LANG INDIV 925071 CDM 982 RC 92507 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 92507 TREATMENT OF SPEECH/LANG INDIV 925071 CDM 982 RC 92507 HCPCS facility both 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price Tx of Speech/Lang/Voice/Comm/Auditory Chg 925072 CDM 440 RC facility both GN 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price Tx of Speech/Lang/Voice/Comm/Auditory Chg 925072 CDM 440 RC facility both GN 400 400 Gross Charge Type: NIHD_Hosp_Profee_Price 92508 TREATMENT OF SPEECH/LANG GROUP 925081 CDM 982 RC 92508 HCPCS facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price 92508 TREATMENT OF SPEECH/LANG GROUP 925081 CDM 982 RC 92508 HCPCS facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price 92508 TREATMENT OF SPEECH/LANG GROUP CHARGE 925082 CDM 440 RC facility both GN 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price 92508 TREATMENT OF SPEECH/LANG GROUP CHARGE 925082 CDM 440 RC facility both GN 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price 92511 NASOPHARYNGOSCOPY W/ENDOSCOPE SPX 925111 CDM 450 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price 92511 NASOPHARYNGOSCOPY W/ENDOSCOPE SPX 925111 CDM 450 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price 92511 NASOPHARYNGOSCOPY ProFee 925112 CDM 982 RC 92511 HCPCS facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price 92511 NASOPHARYNGOSCOPY ProFee 925112 CDM 982 RC 92511 HCPCS facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price VAGINAL DELIVERY LEVEL 2 CHARGE 9251880 CDM 720 RC facility both 4803 4803 Gross Charge Type: NIHD_Hosp_Profee_Price VAGINAL DELIVERY LEVEL 2 CHARGE 9251880 CDM 720 RC facility both 4803 4803 Gross Charge Type: NIHD_Hosp_Profee_Price VAGINAL DELIVERY LEVEL 3 CHARGE 9251881 CDM 720 RC facility both 5801 5801 Gross Charge Type: NIHD_Hosp_Profee_Price VAGINAL DELIVERY LEVEL 3 CHARGE 9251881 CDM 720 RC facility both 5801 5801 Gross Charge Type: NIHD_Hosp_Profee_Price 92521 EVALUATION OF SPEECH FLUENCY 925211 CDM 982 RC 92521 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 92521 EVALUATION OF SPEECH FLUENCY 925211 CDM 982 RC 92521 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Speech Fluency Eval Charge 925212 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Speech Fluency Eval Charge 925212 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 92522 EVALUATION OF SPEECH PRODUCTION 925221 CDM 982 RC 92522 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 92522 EVALUATION OF SPEECH PRODUCTION 925221 CDM 982 RC 92522 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Speech Sound Production Eval Charge 925222 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Speech Sound Production Eval Charge 925222 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 92523 SPEECH SOUND LANG COMPREHEN 925231 CDM 982 RC 92523 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 92523 SPEECH SOUND LANG COMPREHEN 925231 CDM 982 RC 92523 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Speech Sound Prod w/ Language Charge 925232 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Speech Sound Prod w/ Language Charge 925232 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 92524 BEHAVRAL QUALIT ANALYS VOICE 925241 CDM 982 RC 92524 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 92524 BEHAVRAL QUALIT ANALYS VOICE 925241 CDM 982 RC 92524 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Behav/Qual Analysis of Voice and Resonance Charge 925242 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Behav/Qual Analysis of Voice and Resonance Charge 925242 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 92526 TREATMENT SWALLOWING DYSFUNCTI 925261 CDM 982 RC 92526 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price 92526 TREATMENT SWALLOWING DYSFUNCTI 925261 CDM 982 RC 92526 HCPCS facility both 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price Treatment of Swallowing Dysfunction Charge 925262 CDM 440 RC facility both GN 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price Treatment of Swallowing Dysfunction Charge 925262 CDM 440 RC facility both GN 512 512 Gross Charge Type: NIHD_Hosp_Profee_Price "92551 Screening test, pure tone, air only" 92551 CDM 521 RC 92551 HCPCS facility both 20 20 Gross Charge Type: NIHD_RHC_Price "92551 Screening test, pure tone, air only" 92551 CDM 521 RC 92551 HCPCS facility both 18 18 Gross Charge Type: NIHD_Clinic_Price 92552 Pure tone audiometry (threshold); air only 92552 CDM 521 RC 92552 HCPCS facility both 61 61 Gross Charge Type: NIHD_RHC_Price 92552 Pure tone audiometry (threshold); air only 92552 CDM 521 RC 92552 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price 92567 Tympanometry (impedance testing) 92567 CDM 521 RC 92567 HCPCS facility both 40 40 Gross Charge Type: NIHD_RHC_Price 92567 Tympanometry (impedance testing) 92567 CDM 521 RC 92567 HCPCS facility both 40 40 Gross Charge Type: NIHD_Clinic_Price 92597 EVAL FOR USE/FITTING VOICE DEV 925971 CDM 982 RC 92597 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 92597 EVAL FOR USE/FITTING VOICE DEV 925971 CDM 982 RC 92597 HCPCS facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price Eval for Use/Fitting of Voice Prosthetic Dvc Chg 925972 CDM 444 RC facility both GN 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price Eval for Use/Fitting of Voice Prosthetic Dvc Chg 925972 CDM 444 RC facility both GN 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price 92607 1ST HR EVAL SPEECH DEVICE RX 926071 CDM 982 RC 92607 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 92607 1ST HR EVAL SPEECH DEVICE RX 926071 CDM 982 RC 92607 HCPCS facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price Speech Generating Device Evaluation 1st hr Charge 926072 CDM 444 RC facility both GN 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price Speech Generating Device Evaluation 1st hr Charge 926072 CDM 444 RC facility both GN 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price 92609 THERAPEUTIC SVC USE OF SPEECH 926091 CDM 982 RC 92609 HCPCS facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 92609 THERAPEUTIC SVC USE OF SPEECH 926091 CDM 982 RC 92609 HCPCS facility both 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price SLP Speech-Gen Dev Prog and Mod 926092 CDM 440 RC facility both GN 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price SLP Speech-Gen Dev Prog and Mod 926092 CDM 440 RC facility both GN 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price Eval of Oral and Pharyngeal Swallowing Fx Chg 92610 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Eval of Oral and Pharyngeal Swallowing Fx Chg 92610 CDM 444 RC facility both GN 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price Fluoroscopic Evaluation of Swallow Function Charge 92611 CDM 444 RC facility both GN 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price Fluoroscopic Evaluation of Swallow Function Charge 92611 CDM 444 RC facility both GN 700 700 Gross Charge Type: NIHD_Hosp_Profee_Price 92612 ENDOSCOPY SWALLOW (FEES) VID 926121 CDM 982 RC 92612 HCPCS facility both 607 607 Gross Charge Type: NIHD_Hosp_Profee_Price 92612 ENDOSCOPY SWALLOW (FEES) VID 926121 CDM 982 RC 92612 HCPCS facility both 607 607 Gross Charge Type: NIHD_Hosp_Profee_Price Flexible Endoscopic Eval by Cine/Video Charge 926122 CDM 440 RC facility both GN 607 607 Gross Charge Type: NIHD_Hosp_Profee_Price Flexible Endoscopic Eval by Cine/Video Charge 926122 CDM 440 RC facility both GN 607 607 Gross Charge Type: NIHD_Hosp_Profee_Price 92613 FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R 926131 CDM 982 RC 92613 HCPCS facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 92613 FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R 926131 CDM 982 RC 92613 HCPCS facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 92613 FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R CHARGE 926132 CDM 440 RC facility both GN 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 92613 FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R CHARGE 926132 CDM 440 RC facility both GN 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 92614 LARYNGOSCOPIC SENSORY VID 926141 CDM 982 RC 92614 HCPCS facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price 92614 LARYNGOSCOPIC SENSORY VID 926141 CDM 982 RC 92614 HCPCS facility both 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price 92614 SP LARYNSCOP SENSVID CHARGE 926142 CDM 440 RC facility both GN 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price 92614 SP LARYNSCOP SENSVID CHARGE 926142 CDM 440 RC facility both GN 267 267 Gross Charge Type: NIHD_Hosp_Profee_Price 92615 FLEXIBLE ENDOSCOPIC EVAL LARYN SENS C/V REC I&R 926151 CDM 982 RC 92615 HCPCS facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 92615 FLEXIBLE ENDOSCOPIC EVAL LARYN SENS C/V REC I&R 926151 CDM 982 RC 92615 HCPCS facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 92615 FLEXIBLE ENDOSCOPIC EVAL LARYN SENS C/V REC I&R CHARGE 926152 CDM 440 RC facility both GN 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 92615 FLEXIBLE ENDOSCOPIC EVAL LARYN SENS C/V REC I&R CHARGE 926152 CDM 440 RC facility both GN 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 92616 FEES W/LARYNGEAL SENSE TEST 926161 CDM 982 RC 92616 HCPCS facility both 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price 92616 FEES W/LARYNGEAL SENSE TEST 926161 CDM 982 RC 92616 HCPCS facility both 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price 92616 FEES W/LARYNGEAL SENSE TEST CHARGE 926162 CDM 440 RC facility both GN 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price 92616 FEES W/LARYNGEAL SENSE TEST CHARGE 926162 CDM 440 RC facility both GN 644 644 Gross Charge Type: NIHD_Hosp_Profee_Price 92617 FEES W/LARYNGEAL SENSE I&R 926171 CDM 982 RC 92617 HCPCS facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 92617 FEES W/LARYNGEAL SENSE I&R 926171 CDM 982 RC 92617 HCPCS facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 92617 SP FEES W/LARYNSENI&R CHARGE 926172 CDM 440 RC facility both GN 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 92617 SP FEES W/LARYNSENI&R CHARGE 926172 CDM 440 RC facility both GN 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price CORPORATE MASK FIT TESTING Charge 9263969 CDM 999 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price CORPORATE MASK FIT TESTING Charge 9263969 CDM 999 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price GENERAL PUBLIC MASK FIT TESTING Charge 9263970 CDM 999 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price GENERAL PUBLIC MASK FIT TESTING Charge 9263970 CDM 999 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 92651 NEWBORN OP HEARING SCREEN FOLLOW UP CHARGE 926511 CDM 470 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price 92651 NEWBORN OP HEARING SCREEN FOLLOW UP CHARGE 926511 CDM 470 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price 92651 NEWBORN HEARING SCREEN CHARGE 926512 CDM 470 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price 92651 NEWBORN HEARING SCREEN CHARGE 926512 CDM 470 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price T- and B-Lymphocyte/Nat Killer LC 9275174 CDM 301 RC facility both 17.3 17.3 Gross Charge Type: NIHD_Hosp_Profee_Price T- and B-Lymphocyte/Nat Killer LC 9275174 CDM 301 RC facility both 17.3 17.3 Gross Charge Type: NIHD_Hosp_Profee_Price ToxASSURE Select 13 (MW) LC 9275241 CDM 80307 HCPCS facility both 8.34 8.34 Gross Charge Type: NIHD_Clinic_Price ToxASSURE Select 13 (MW) LC 9275241 CDM 301 RC facility both 8.34 8.34 Gross Charge Type: NIHD_Hosp_Profee_Price ToxASSURE Select 13 (MW) LC 9275241 CDM 301 RC facility both 8.34 8.34 Gross Charge Type: NIHD_Hosp_Profee_Price "Compliance Drug Analysis, Ur LC" 9275242 CDM 301 RC 80307 HCPCS facility both 115 115 Gross Charge Type: NIHD_RHC_Price "Compliance Drug Analysis, Ur LC" 9275242 CDM 301 RC 80307 HCPCS facility both 115 115 Gross Charge Type: NIHD_Clinic_Price "Compliance Drug Analysis, Ur LC" 9275242 CDM 301 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price "Compliance Drug Analysis, Ur LC" 9275242 CDM 301 RC facility both 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price INSTITITIONAL SCREENINGPFT Charge 9279400 CDM 460 RC facility both 319 319 Gross Charge Type: NIHD_Hosp_Profee_Price INSTITITIONAL SCREENINGPFT Charge 9279400 CDM 460 RC facility both 319 319 Gross Charge Type: NIHD_Hosp_Profee_Price 92950 PHY CPR ProFee 92950 CDM 963 RC 92950 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price 92950 PHY CPR ProFee 92950 CDM 963 RC 92950 HCPCS facility both 1187 1187 Gross Charge Type: NIHD_Hosp_Profee_Price 92950 CARDIOPULMONARY RESUSCITATION TechFee 929502 CDM 450 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price 92950 CARDIOPULMONARY RESUSCITATION TechFee 929502 CDM 450 RC facility both 1336 1336 Gross Charge Type: NIHD_Hosp_Profee_Price 92960 PHY CARDIOVERSION EXTERNAL ProFee 92960 CDM 982 RC 92960 HCPCS facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 92960 PHY CARDIOVERSION EXTERNAL ProFee 92960 CDM 982 RC 92960 HCPCS facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "Cardioversion Elective, External" 929601 CDM 761 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price "Cardioversion Elective, External" 929601 CDM 761 RC facility both 111 111 Gross Charge Type: NIHD_Hosp_Profee_Price 92977 CORONARY THROMBOLYSIS BY INTRAVENOUS INFUSION TechFee 929771 CDM 450 RC facility both 887 887 Gross Charge Type: NIHD_Hosp_Profee_Price 92977 CORONARY THROMBOLYSIS BY INTRAVENOUS INFUSION TechFee 929771 CDM 450 RC facility both 887 887 Gross Charge Type: NIHD_Hosp_Profee_Price 92977 CORONARY THROMBOLYSIS BY INTRAVENOUS INFUSION ProFee 929772 CDM 982 RC 92977 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price 92977 CORONARY THROMBOLYSIS BY INTRAVENOUS INFUSION ProFee 929772 CDM 982 RC 92977 HCPCS facility both 1872 1872 Gross Charge Type: NIHD_Hosp_Profee_Price 93000 EKG w/ 12+ leads; tracing/interp/report 93000 CDM 521 RC 93000 HCPCS facility both 18 18 Gross Charge Type: NIHD_RHC_Price 93000 EKG w/ 12+ leads; tracing/interp/report 93000 CDM 521 RC 93000 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price 93005 EKG ROUTINE CHARGE 930051 CDM 730 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 93005 EKG ROUTINE CHARGE 930051 CDM 730 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 03.0 BUNDLE 9300520 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 03.0 BUNDLE 9300520 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price RT Electrocardiogram (EKG) CHARGE 9300521 CDM 730 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price RT Electrocardiogram (EKG) CHARGE 9300521 CDM 730 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price CV ECG Acquisition 9300522 CDM 93005 HCPCS facility both 132 132 Gross Charge Type: NIHD_Clinic_Price CV ECG Acquisition 9300522 CDM 730 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price CV ECG Acquisition 9300522 CDM 730 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price CV ECG Report 93010 CDM 985 RC 93010 HCPCS facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price CV ECG Report 93010 CDM 985 RC 93010 HCPCS facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price 93010 EKG w/ 12+ leads; Interp/Report Only 930101 CDM 521 RC 93010 HCPCS facility both 18 18 Gross Charge Type: NIHD_Clinic_Price 93010 EKG INTERPRETATION & REPORT ProFee 930102 CDM 985 RC 93010 HCPCS facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price 93010 EKG INTERPRETATION & REPORT ProFee 930102 CDM 985 RC 93010 HCPCS facility both 40 40 Gross Charge Type: NIHD_Hosp_Profee_Price 93015 STRESS TEST ProFee 93015 CDM 985 RC 93015 HCPCS facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price 93015 STRESS TEST ProFee 93015 CDM 985 RC 93015 HCPCS facility both 228 228 Gross Charge Type: NIHD_Hosp_Profee_Price 93016 Stress Test Supervision ProFee [INYO] 93016 CDM 521 RC 93016 HCPCS facility both 102 102 Gross Charge Type: NIHD_Clinic_Price 93016 STRESS TEST SUPERVISION ProFee 930161 CDM 985 RC 93016 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 93016 STRESS TEST SUPERVISION ProFee 930161 CDM 985 RC 93016 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price "93017 CARDIO STRESS TEST,TREADMILL OR PHARMA CHARGE" 930172 CDM 480 RC facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price "93017 CARDIO STRESS TEST,TREADMILL OR PHARMA CHARGE" 930172 CDM 480 RC facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price Stress Test Treadmill 930173 CDM 480 RC facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price Stress Test Treadmill 930173 CDM 480 RC facility both 1248 1248 Gross Charge Type: NIHD_Hosp_Profee_Price 93018 Stress Test Interpretation ProFee [INYO] 93018 CDM 521 RC 93018 HCPCS facility both 167 167 Gross Charge Type: NIHD_Clinic_Price 93018 STRESS TEST INTERPRETATION ProFee 93018 CDM 985 RC 93018 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price 93018 STRESS TEST INTERPRETATION ProFee 93018 CDM 985 RC 93018 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price Rhythm Strip 93041 CDM 730 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price Rhythm Strip 93041 CDM 730 RC facility both 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price 93042 ECG RHYTHM INTR&REPT ONLY ProFee 93042 CDM 985 RC 93042 HCPCS facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price 93042 ECG RHYTHM INTR&REPT ONLY ProFee 93042 CDM 985 RC 93042 HCPCS facility both 31 31 Gross Charge Type: NIHD_Hosp_Profee_Price "93224 Holter ECG Monitor, up to 48 hr, w/ scan, interp, and report" 93224 CDM 521 RC 93224 HCPCS facility both 558 558 Gross Charge Type: NIHD_Clinic_Price Holter Monitor 24-48 Hours 93225 CDM 731 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price Holter Monitor 24-48 Hours 93225 CDM 731 RC facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 93227 HOLTER MONITOR 48 HOURS PF ProFee 93227 CDM 982 RC 93227 HCPCS facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 93227 HOLTER MONITOR 48 HOURS PF ProFee 93227 CDM 982 RC 93227 HCPCS facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 93228 XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS ProFee 93228 CDM 982 RC 93228 HCPCS facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 93228 XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS ProFee 93228 CDM 982 RC 93228 HCPCS facility both 63 63 Gross Charge Type: NIHD_Hosp_Profee_Price 93229 Remote 30 day ecg tech support 93229 CDM 730 RC facility both 52 978 978 Gross Charge Type: NIHD_Hosp_Profee_Price 93229 Remote 30 day ecg tech support 93229 CDM 730 RC facility both 52 978 978 Gross Charge Type: NIHD_Hosp_Profee_Price 93242 ZIO EXTERNAL ECG REC>48HR<7D RECORDING CHARGE 93242 CDM 731 RC facility both 59 59 Gross Charge Type: NIHD_Hosp_Profee_Price 93242 ZIO EXTERNAL ECG REC>48HR<7D RECORDING CHARGE 93242 CDM 731 RC facility both 59 59 Gross Charge Type: NIHD_Hosp_Profee_Price 93242 ZIO EXTERNAL ECG REC>48HR<7D RECORDING CHARGE 932421 CDM 731 RC facility both 59 59 Gross Charge Type: NIHD_Hosp_Profee_Price 93242 ZIO EXTERNAL ECG REC>48HR<7D RECORDING CHARGE 932421 CDM 731 RC facility both 59 59 Gross Charge Type: NIHD_Hosp_Profee_Price 93244 ZIO EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION PROFEE 93244 CDM 985 RC 93244 HCPCS facility both 44 44 Gross Charge Type: NIHD_Hosp_Profee_Price 93244 ZIO EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION PROFEE 93244 CDM 985 RC 93244 HCPCS facility both 44 44 Gross Charge Type: NIHD_Hosp_Profee_Price 93246 ZIO EXTERNAL ECG REC>7D<15D RECORDING CHARGE 93246 CDM 731 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price 93246 ZIO EXTERNAL ECG REC>7D<15D RECORDING CHARGE 93246 CDM 731 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price 93246 ZIO EXTERNAL ECG REC>7D<15D RECORDING CHARGE 932461 CDM 731 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price 93246 ZIO EXTERNAL ECG REC>7D<15D RECORDING CHARGE 932461 CDM 731 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price 93248 ZIO EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION PROFEE 93248 CDM 985 RC 93248 HCPCS facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price 93248 ZIO EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION PROFEE 93248 CDM 985 RC 93248 HCPCS facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price RT Event Monitor Recording CHARGE 932701 CDM 481 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price RT Event Monitor Recording CHARGE 932701 CDM 481 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 93270 PD CEM W PSL/30;RECORDING ProFee 932702 CDM 982 RC 93270 HCPCS facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 93270 PD CEM W PSL/30;RECORDING ProFee 932702 CDM 982 RC 93270 HCPCS facility both 76 76 Gross Charge Type: NIHD_Hosp_Profee_Price 93279 Programming device evaluation (in person); single lead pacemaker system 932791 CDM 93279 HCPCS facility both 220 220 Gross Charge Type: NIHD_Clinic_Price 93279 INTERROGATOR SINGLE LEAD CHARGE 932792 CDM 480 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price 93279 INTERROGATOR SINGLE LEAD CHARGE 932792 CDM 480 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price 93280 INTERROGATOR DUAL LEAD CHARGE 93280 CDM 480 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 93280 INTERROGATOR DUAL LEAD CHARGE 93280 CDM 480 RC facility both 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price 93280 Programming device evaluation (in person); dual lead pacemaker system 932801 CDM 93280 HCPCS facility both 257 257 Gross Charge Type: NIHD_Clinic_Price 93281 Programming device evaluation (in person); multiple lead pacemaker system 932811 CDM 93281 HCPCS facility both 272 272 Gross Charge Type: NIHD_Clinic_Price 93282 INTERROGATOR ICD SINGLE Charge 93282 CDM 480 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price 93282 INTERROGATOR ICD SINGLE Charge 93282 CDM 480 RC facility both 195 195 Gross Charge Type: NIHD_Hosp_Profee_Price 93282 Programming device evaluation; single lead transvenous implantable defibrillator system 932821 CDM 93282 HCPCS facility both 250 250 Gross Charge Type: NIHD_Clinic_Price 93283 Programming device evaluation; dual lead transvenous implantable defibrillator system 93283 CDM 93283 HCPCS facility both 306 306 Gross Charge Type: NIHD_Clinic_Price 93283 INTERROGATOR ICD DUAL LEAD CHARGE 932831 CDM 480 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 93283 INTERROGATOR ICD DUAL LEAD CHARGE 932831 CDM 480 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 93284 INTERROGATOR ICD MULTI Charge 93284 CDM 480 RC facility both 224 224 Gross Charge Type: NIHD_Hosp_Profee_Price 93284 INTERROGATOR ICD MULTI Charge 93284 CDM 480 RC facility both 224 224 Gross Charge Type: NIHD_Hosp_Profee_Price 93284 Programming device evaluation; multiple lead transvenous implantable defibrillator system 932841 CDM 93284 HCPCS facility both 330 330 Gross Charge Type: NIHD_Clinic_Price 93285 Programming device evaluation (in person); implantable loop recorder system 932851 CDM 93285 HCPCS facility both 195 195 Gross Charge Type: NIHD_Clinic_Price "93288 Interrogation device evaluation (in person) ; single, dual, or multiple lead pacemaker system" 932881 CDM 93288 HCPCS facility both 184 184 Gross Charge Type: NIHD_Clinic_Price "93291 Interrogation device evaluation; loop recorder system, including heart rhythm data analysis" 932911 CDM 93291 HCPCS facility both 160 160 Gross Charge Type: NIHD_Clinic_Price "93294 Interrogation device evaluation, up to 90 days; single, dual, or multiple lead pacemaker" 932941 CDM 93294 HCPCS facility both 91 91 Gross Charge Type: NIHD_Clinic_Price "93295 Interrogation device eval remote, up to 90 days; single, dual, or multiple lead implant defib" 932951 CDM 93295 HCPCS facility both 113 113 Gross Charge Type: NIHD_Clinic_Price "93296 Interrogation device eval, up to 90 days; single, dual, or mult pacemaker or implant defib" 932961 CDM 93296 HCPCS facility both 72 72 Gross Charge Type: NIHD_Clinic_Price "93298 Interrogation device eval, (remote) up to 30 days; implant loop recorder, heart rhythm data" 932981 CDM 93298 HCPCS facility both 337 337 Gross Charge Type: NIHD_Clinic_Price TRANSTHORACIC CARDIAC ECHO - CONGENITAL COMPLETE 933031 CDM 483 RC facility both 2186 2186 Gross Charge Type: NIHD_Hosp_Profee_Price TRANSTHORACIC CARDIAC ECHO - CONGENITAL COMPLETE 933031 CDM 483 RC facility both 2186 2186 Gross Charge Type: NIHD_Hosp_Profee_Price US Echo Congenital Anomalies Complete EO 933032 CDM 483 RC facility both 2186 2186 Gross Charge Type: NIHD_Hosp_Profee_Price US Echo Congenital Anomalies Complete EO 933032 CDM 483 RC facility both 2186 2186 Gross Charge Type: NIHD_Hosp_Profee_Price TRANSTHORACIC CARDIAC ECHO - LIMITED/FOLLOW UP 933041 CDM 483 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price TRANSTHORACIC CARDIAC ECHO - LIMITED/FOLLOW UP 933041 CDM 483 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price US Echo Congenital Limited 933042 CDM 483 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price US Echo Congenital Limited 933042 CDM 483 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price US Echo Bubble Study EO 93306 CDM 483 RC facility both 2534 2534 Gross Charge Type: NIHD_Hosp_Profee_Price US Echo Bubble Study EO 93306 CDM 483 RC facility both 2534 2534 Gross Charge Type: NIHD_Hosp_Profee_Price 93306 ECHO-2D W/SPECTRL-COLOR DOPPLR CHARGE 933061 CDM 483 RC facility both 2534 2534 Gross Charge Type: NIHD_Hosp_Profee_Price 93306 ECHO-2D W/SPECTRL-COLOR DOPPLR CHARGE 933061 CDM 483 RC facility both 2534 2534 Gross Charge Type: NIHD_Hosp_Profee_Price US Echocardiogram Complete EO 9330612 CDM 483 RC facility both 2534 2534 Gross Charge Type: NIHD_Hosp_Profee_Price US Echocardiogram Complete EO 9330612 CDM 483 RC facility both 2534 2534 Gross Charge Type: NIHD_Hosp_Profee_Price 93306 2D ECHO COMPLETE PRO FEE 933062 CDM 982 RC 93306 HCPCS facility both 26 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price 93306 2D ECHO COMPLETE PRO FEE 933062 CDM 982 RC 93306 HCPCS facility both 26 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price RT TTE Complete CHARGE 933063 CDM 483 RC facility both 2534 2534 Gross Charge Type: NIHD_Hosp_Profee_Price RT TTE Complete CHARGE 933063 CDM 483 RC facility both 2534 2534 Gross Charge Type: NIHD_Hosp_Profee_Price 93306 2D ECHO COMPLETE PRO FEE 933064 CDM 982 RC 93306 HCPCS facility both 26 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price 93306 2D ECHO COMPLETE PRO FEE 933064 CDM 982 RC 93306 HCPCS facility both 26 551 551 Gross Charge Type: NIHD_Hosp_Profee_Price Echocardiogram Limited 93308 CDM 483 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price Echocardiogram Limited 93308 CDM 483 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 93308 Echo TTE Follow Up or Limited 2D POC 933081 CDM 483 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 93308 Echo TTE Follow Up or Limited 2D POC 933081 CDM 483 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 93308 2-D Limited Charge 933082 CDM 483 RC facility both TC 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 93308 2-D Limited Charge 933082 CDM 483 RC facility both TC 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price US Echocardiogram Limited EO 9330823 CDM 483 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price US Echocardiogram Limited EO 9330823 CDM 483 RC facility both 851 851 Gross Charge Type: NIHD_Hosp_Profee_Price 93308 ECHOCARDIOGRAM FOLLOW UP ProFee 933083 CDM 982 RC 93308 HCPCS facility both 26 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price 93308 ECHOCARDIOGRAM FOLLOW UP ProFee 933083 CDM 982 RC 93308 HCPCS facility both 26 295 295 Gross Charge Type: NIHD_Hosp_Profee_Price RT Transesophageal Echo (TEE) CHARGE 933121 CDM 483 RC facility both 3060 3060 Gross Charge Type: NIHD_Hosp_Profee_Price RT Transesophageal Echo (TEE) CHARGE 933121 CDM 483 RC facility both 3060 3060 Gross Charge Type: NIHD_Hosp_Profee_Price US Echo TEE EO 9331212 CDM 483 RC facility both 3060 3060 Gross Charge Type: NIHD_Hosp_Profee_Price US Echo TEE EO 9331212 CDM 483 RC facility both 3060 3060 Gross Charge Type: NIHD_Hosp_Profee_Price 93312 ECHO TRANSESOPHAGEAL ProFee 933122 CDM 982 RC 93312 HCPCS facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price 93312 ECHO TRANSESOPHAGEAL ProFee 933122 CDM 982 RC 93312 HCPCS facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price RT Echo Doppler Complete CHARGE 933201 CDM 483 RC facility both 883 883 Gross Charge Type: NIHD_Hosp_Profee_Price RT Echo Doppler Complete CHARGE 933201 CDM 483 RC facility both 883 883 Gross Charge Type: NIHD_Hosp_Profee_Price 93320 DOPPLER ECHO COMPLETE ProFee 933202 CDM 982 RC 93320 HCPCS facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price 93320 DOPPLER ECHO COMPLETE ProFee 933202 CDM 982 RC 93320 HCPCS facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price RT Echo Limited Study CHARGE 933211 CDM 483 RC facility both 542 542 Gross Charge Type: NIHD_Hosp_Profee_Price RT Echo Limited Study CHARGE 933211 CDM 483 RC facility both 542 542 Gross Charge Type: NIHD_Hosp_Profee_Price 9332126 DOPPLER ECHO LIMITED F UP ProFee 933212 CDM 982 RC 93321 HCPCS facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 9332126 DOPPLER ECHO LIMITED F UP ProFee 933212 CDM 982 RC 93321 HCPCS facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price 93325 Doppler echocardiography color flow velocity mapping 933251 CDM 521 RC 93325 HCPCS facility both 51 51 Gross Charge Type: NIHD_RHC_Price RT Echo Doppler Color Flow CHARGE 933252 CDM 483 RC facility both 782 782 Gross Charge Type: NIHD_Hosp_Profee_Price RT Echo Doppler Color Flow CHARGE 933252 CDM 483 RC facility both 782 782 Gross Charge Type: NIHD_Hosp_Profee_Price 93325 DOP ECHOCARD COLOR FLOW VELOCITY MAPPING ProFee 933253 CDM 982 RC 93325 HCPCS facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price 93325 DOP ECHOCARD COLOR FLOW VELOCITY MAPPING ProFee 933253 CDM 982 RC 93325 HCPCS facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price Stress Echo 933501 CDM 482 RC facility both 1449 1449 Gross Charge Type: NIHD_Hosp_Profee_Price Stress Echo 933501 CDM 482 RC facility both 1449 1449 Gross Charge Type: NIHD_Hosp_Profee_Price US Stress Echo EO 933502 CDM 482 RC facility both 1449 1449 Gross Charge Type: NIHD_Hosp_Profee_Price US Stress Echo EO 933502 CDM 482 RC facility both 1449 1449 Gross Charge Type: NIHD_Hosp_Profee_Price 93350 ECHOCARDIOGRAPHY STRESS TST PF ProFee 933503 CDM 982 RC 93350 HCPCS facility both 814 814 Gross Charge Type: NIHD_Hosp_Profee_Price 93350 ECHOCARDIOGRAPHY STRESS TST PF ProFee 933503 CDM 982 RC 93350 HCPCS facility both 814 814 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Swing Bed Advanced 9336988 CDM 110 RC facility both 10459 10459 Gross Charge Type: NIHD_Hosp_Profee_Price ROOM/BED: Swing Bed Advanced 9336988 CDM 110 RC facility both 10459 10459 Gross Charge Type: NIHD_Hosp_Profee_Price H0033 Oral medication administration 9345780 CDM H0033 HCPCS facility both 5 5 Gross Charge Type: NIHD_Clinic_Price "93784 Amb BP, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer" 93784 CDM 521 RC 93784 HCPCS facility both 84 84 Gross Charge Type: NIHD_RHC_Price "93784 Amb BP, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer" 93784 CDM 521 RC 93784 HCPCS facility both 84 84 Gross Charge Type: NIHD_Clinic_Price "93784 Amb BP, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer" 93784 CDM 480 RC 93784 HCPCS facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "93784 Amb BP, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer" 93784 CDM 480 RC 93784 HCPCS facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price Ambulatory Blood Pressure Monitor 937841 CDM 480 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price Ambulatory Blood Pressure Monitor 937841 CDM 480 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "93786 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer" 93786 CDM 521 RC 93786 HCPCS facility both 56 56 Gross Charge Type: NIHD_RHC_Price "93786 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer" 93786 CDM 521 RC 93786 HCPCS facility both 56 56 Gross Charge Type: NIHD_Clinic_Price "93788 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer" 93788 CDM 521 RC 93788 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price "93788 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer" 93788 CDM 521 RC 93788 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price US Carotid Duplex Bilateral - Report 938801 CDM 972 RC 93880 HCPCS facility both 26 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price US Carotid Duplex Bilateral - Report 938801 CDM 972 RC 93880 HCPCS facility both 26 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price US Carotid Duplex Bilateral 938802 CDM 921 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Carotid Duplex Bilateral 938802 CDM 921 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Carotid Duplex Unilat/Limited - Report 938821 CDM 982 RC 93882 HCPCS facility both 26 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Carotid Duplex Unilat/Limited - Report 938821 CDM 982 RC 93882 HCPCS facility both 26 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Carotid Duplex Unilat/Limited 938822 CDM 402 RC facility both TC 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Carotid Duplex Unilat/Limited 938822 CDM 402 RC facility both TC 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US ABI 939221 CDM 402 RC facility both TC 482 482 Gross Charge Type: NIHD_Hosp_Profee_Price US ABI 939221 CDM 402 RC facility both TC 482 482 Gross Charge Type: NIHD_Hosp_Profee_Price US ABI - Report 939222 CDM 982 RC 93922 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price US ABI - Report 939222 CDM 982 RC 93922 HCPCS facility both 26 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 93922 Limited bilateral noninvasive physiologic studies of upper/lower extremity arteries 939223 CDM 982 RC 93922 HCPCS facility both 620 620 Gross Charge Type: NIHD_Hosp_Tech_Price 93922 Limited bilateral noninvasive physiologic studies of upper/lower extremity arteries 939223 CDM 982 RC 93922 HCPCS facility both 620 620 Gross Charge Type: NIHD_Hosp_Tech_Price 93922 Limited bilateral noninvasive physiologic studies of upper/lower extremity arteries 939223 CDM 982 RC 93922 HCPCS facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price 93922 Limited bilateral noninvasive physiologic studies of upper/lower extremity arteries 939223 CDM 982 RC 93922 HCPCS facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price 93922 Limited bilateral noninvasive physiologic studies of upper/lower extremity arteries 939223_761 CDM 761 RC 93922 HCPCS facility both 620 620 Gross Charge Type: NIHD_Hosp_Tech_Price 93922 Limited bilateral noninvasive physiologic studies of upper/lower extremity arteries 939223_761 CDM 761 RC 93922 HCPCS facility both 620 620 Gross Charge Type: NIHD_Hosp_Tech_Price 93922 Limited bilateral noninvasive physiologic studies of upper/lower extremity arteries 939223_761 CDM 761 RC 93922 HCPCS facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price 93922 Limited bilateral noninvasive physiologic studies of upper/lower extremity arteries 939223_761 CDM 761 RC 93922 HCPCS facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price 93922 PHYS STUDY EXTR ARTERY UP OR L ProFee 939225 CDM 982 RC 93922 HCPCS facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price 93922 PHYS STUDY EXTR ARTERY UP OR L ProFee 939225 CDM 982 RC 93922 HCPCS facility both 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price 93922 Limited Unilateral noninvasive physiologic studies of upper/lower extremity arteries 939226 CDM 982 RC 93922 HCPCS facility both 52 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price 93922 Limited Unilateral noninvasive physiologic studies of upper/lower extremity arteries 939226 CDM 982 RC 93922 HCPCS facility both 52 131 131 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Bilateral - Report 939251 CDM 972 RC 93925 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Bilateral - Report 939251 CDM 972 RC 93925 HCPCS facility both 26 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Bilateral 939252 CDM 402 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Bilateral 939252 CDM 402 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Right - Report 939261 CDM 972 RC 93926 HCPCS facility both 26RT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Right - Report 939261 CDM 972 RC 93926 HCPCS facility both 26RT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Left - Report 939262 CDM 972 RC 93926 HCPCS facility both 26LT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Left - Report 939262 CDM 972 RC 93926 HCPCS facility both 26LT 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Left 939263 CDM 402 RC facility both TCLT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Left 939263 CDM 402 RC facility both TCLT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Right 939264 CDM 402 RC facility both TCRT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Arterial Duplex Right 939264 CDM 402 RC facility both TCRT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Bilateral - Report 939301 CDM 972 RC 93930 HCPCS facility both 2650 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Bilateral - Report 939301 CDM 972 RC 93930 HCPCS facility both 2650 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Bilateral 939302 CDM 921 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Bilateral 939302 CDM 921 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Right - Report 939311 CDM 972 RC 93931 HCPCS facility both 26RT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Right - Report 939311 CDM 972 RC 93931 HCPCS facility both 26RT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Left - Report 939312 CDM 972 RC 93931 HCPCS facility both 26LT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Left - Report 939312 CDM 972 RC 93931 HCPCS facility both 26LT 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Left 939313 CDM 402 RC facility both TCLT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Left 939313 CDM 402 RC facility both TCLT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Right 939314 CDM 402 RC facility both TCRT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Arterial Duplex Right 939314 CDM 402 RC facility both TCRT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Venous Duplex Bilateral 93970_921 CDM 921 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Venous Duplex Bilateral 93970_921 CDM 921 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Venous Duplex Bilateral - Report 93970_972 CDM 972 RC 93970 HCPCS facility both 2650 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Venous Duplex Bilateral - Report 93970_972 CDM 972 RC 93970 HCPCS facility both 2650 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Bilateral - Report 939701 CDM 972 RC 93970 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Bilateral - Report 939701 CDM 972 RC 93970 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Bilateral 939702 CDM 402 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Bilateral 939702 CDM 402 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Bilateral 939703 CDM 921 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Bilateral 939703 CDM 921 RC facility both TC 1519 1519 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Bilateral - Report 939704 CDM 972 RC 93970 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Bilateral - Report 939704 CDM 972 RC 93970 HCPCS facility both 26 186 186 Gross Charge Type: NIHD_Hosp_Profee_Price 93971 US LUpper Ext Venous Duplex Tech Fee 93971_450 CDM 450 RC facility both 1189 1189 Gross Charge Type: NIHD_Hosp_Profee_Price 93971 US Lower Ext Venous Duplex 93971_450 CDM 450 RC facility both 1189 1189 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Venous Duplex 93971_921 CDM 921 RC facility both TC 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Venous Duplex 93971_921 CDM 921 RC facility both TCRT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Venous Duplex - Report 93971_972 CDM 972 RC 93971 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Upper Ext Venous Duplex - Report 93971_972 CDM 972 RC 93971 HCPCS facility both 26LT 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY 939711 CDM 982 RC 93971 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY 939711 CDM 982 RC 93971 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Right - Report 939712 CDM 972 RC 93971 HCPCS facility both 26RT 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Right - Report 939712 CDM 972 RC 93971 HCPCS facility both 26RT 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Left - Report 939713 CDM 972 RC 93971 HCPCS facility both 26LT 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Left - Report 939713 CDM 972 RC 93971 HCPCS facility both 26LT 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Left 939714 CDM 402 RC facility both TCLT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Left 939714 CDM 402 RC facility both TCLT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Right 939715 CDM 402 RC facility both TCRT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Duplex Right 939715 CDM 402 RC facility both TCRT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Left - Report 939717 CDM 972 RC 93971 HCPCS facility both 26LT 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Left - Report 939717 CDM 972 RC 93971 HCPCS facility both 26LT 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Right 939718_402 CDM 402 RC facility both TC 1189 1189 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Right 939718_402 CDM 402 RC facility both TC 1189 1189 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Right - Report 939718_972 CDM 972 RC 93971 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Right - Report 939718_972 CDM 972 RC 93971 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Left 939719 CDM 402 RC facility both TCLT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Lower Ext Venous Reflux Left 939719 CDM 402 RC facility both TCLT 1037 1037 Gross Charge Type: NIHD_Hosp_Profee_Price US Aorta IVC Iliac Duplex Complete - Report 939781 CDM 972 RC 93978 HCPCS facility both 26 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price US Aorta IVC Iliac Duplex Complete - Report 939781 CDM 972 RC 93978 HCPCS facility both 26 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price US Aorta IVC Iliac Duplex Complete 939782 CDM 402 RC facility both TC 1267 1267 Gross Charge Type: NIHD_Hosp_Profee_Price US Aorta IVC Iliac Duplex Complete 939782 CDM 402 RC facility both TC 1267 1267 Gross Charge Type: NIHD_Hosp_Profee_Price US Aorta IVC Iliac Duplex Limited - Report 939791 CDM 972 RC 93979 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Aorta IVC Iliac Duplex Limited - Report 939791 CDM 972 RC 93979 HCPCS facility both 26 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price US Aorta IVC Iliac Duplex Limited 939792 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Aorta IVC Iliac Duplex Limited 939792 CDM 402 RC facility both TC 901 901 Gross Charge Type: NIHD_Hosp_Profee_Price US Duplex Penile Art/Veins Limited 939811 CDM 402 RC facility both TC 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price US Duplex Penile Art/Veins Limited 939811 CDM 402 RC facility both TC 770 770 Gross Charge Type: NIHD_Hosp_Profee_Price US Duplex Penile Art/Veins Limited - Report 939812 CDM 982 RC 93981 HCPCS facility both 26 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price US Duplex Penile Art/Veins Limited - Report 939812 CDM 982 RC 93981 HCPCS facility both 26 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Revision Trabeculectomy 9398358 CDM 360 RC facility both 11056 11056 Gross Charge Type: NIHD_Hosp_Profee_Price Revision Trabeculectomy 9398358 CDM 360 RC facility both 11056 11056 Gross Charge Type: NIHD_Hosp_Profee_Price Canaloplasty 9398361 CDM 360 RC facility both 11799 11799 Gross Charge Type: NIHD_Hosp_Profee_Price Canaloplasty 9398361 CDM 360 RC facility both 11799 11799 Gross Charge Type: NIHD_Hosp_Profee_Price US Duplex Hemodialysis Access 939901 CDM 921 RC facility both TC 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price US Duplex Hemodialysis Access 939901 CDM 921 RC facility both TC 985 985 Gross Charge Type: NIHD_Hosp_Profee_Price US Duplex Hemodialysis Access - Report 939902 CDM 972 RC 93990 HCPCS facility both 26 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price US Duplex Hemodialysis Access - Report 939902 CDM 972 RC 93990 HCPCS facility both 26 403 403 Gross Charge Type: NIHD_Hosp_Profee_Price RT Ventilator Services Initial CHARGE 940022 CDM 412 RC facility both 3992 3992 Gross Charge Type: NIHD_Hosp_Profee_Price RT Ventilator Services Initial CHARGE 940022 CDM 412 RC facility both 3992 3992 Gross Charge Type: NIHD_Hosp_Profee_Price RT Ventilator Services Subsequent CHARGE 94003 CDM 412 RC facility both 2894 2894 Gross Charge Type: NIHD_Hosp_Profee_Price RT Ventilator Services Subsequent CHARGE 94003 CDM 412 RC facility both 2894 2894 Gross Charge Type: NIHD_Hosp_Profee_Price 94010 Basic Spirometry Charge 94010 CDM 460 RC facility both TC 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price 94010 Basic Spirometry Charge 94010 CDM 460 RC facility both TC 488 488 Gross Charge Type: NIHD_Hosp_Profee_Price 94010 BASIC SPIROMETRY PROFEE 940101 CDM 982 RC 94010 HCPCS facility both 26 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price 94010 BASIC SPIROMETRY PROFEE 940101 CDM 982 RC 94010 HCPCS facility both 26 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price "94060 Bronchodilation responsiveness, spirometry pre and post interp" 940601 CDM 521 RC 94060 HCPCS facility both 197 197 Gross Charge Type: NIHD_RHC_Price 94060 SPIRO W-BRONCH PRO FEE 940602 CDM 982 RC 94060 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 94060 SPIRO W-BRONCH PRO FEE 940602 CDM 982 RC 94060 HCPCS facility both 26 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 94060 RT ONLY - BRONCHODILATOR SPIROMETRY 940603 CDM 460 RC facility both TC 987 987 Gross Charge Type: NIHD_Hosp_Profee_Price 94060 RT ONLY - BRONCHODILATOR SPIROMETRY 940603 CDM 460 RC facility both TC 987 987 Gross Charge Type: NIHD_Hosp_Profee_Price "94150 Vital capacity, total" 94150 CDM 521 RC 94150 HCPCS facility both 43 43 Gross Charge Type: NIHD_RHC_Price "94150 Vital capacity, total" 94150 CDM 521 RC 94150 HCPCS facility both 43 43 Gross Charge Type: NIHD_Clinic_Price 94200 Lung Function Test 94200 CDM 521 RC 94200 HCPCS facility both 48 48 Gross Charge Type: NIHD_RHC_Price 94200 Lung Function Test 94200 CDM 521 RC 94200 HCPCS facility both 48 48 Gross Charge Type: NIHD_Clinic_Price EPIDURAL/SPINAL ANEST INITIAL 30 MIN 9453875 CDM 370 RC facility both 546 546 Gross Charge Type: NIHD_Hosp_Profee_Price EPIDURAL/SPINAL ANEST INITIAL 30 MIN 9453875 CDM 370 RC facility both 546 546 Gross Charge Type: NIHD_Hosp_Profee_Price EPIDURAL/SPINAL ANEST ADD 15 (EACH) 9453876 CDM 370 RC facility both 1584 1584 Gross Charge Type: NIHD_Hosp_Profee_Price EPIDURAL/SPINAL ANEST ADD 15 (EACH) 9453876 CDM 370 RC facility both 1584 1584 Gross Charge Type: NIHD_Hosp_Profee_Price IV PROC SEDATION OR ENDOSCOPY INITIAL 15 MIN 9453877 CDM 370 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price IV PROC SEDATION OR ENDOSCOPY INITIAL 15 MIN 9453877 CDM 370 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price IV PROC SEDATION OR ENDOSCOPY ADD'L 15 MIN 9453878 CDM 370 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price IV PROC SEDATION OR ENDOSCOPY ADD'L 15 MIN 9453878 CDM 370 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price Six Minute Walk 946181 CDM 460 RC facility both 245 245 Gross Charge Type: NIHD_Hosp_Profee_Price Six Minute Walk 946181 CDM 460 RC facility both 245 245 Gross Charge Type: NIHD_Hosp_Profee_Price Six Minute Walk 946182 CDM 460 RC facility both 245 245 Gross Charge Type: NIHD_Hosp_Profee_Price Six Minute Walk 946182 CDM 460 RC facility both 245 245 Gross Charge Type: NIHD_Hosp_Profee_Price 94640 Airway inhalation treatment 946401 CDM 521 RC 94640 HCPCS facility both 45 45 Gross Charge Type: NIHD_RHC_Price 94640 Airway inhalation treatment 946401 CDM 521 RC 94640 HCPCS facility both 45 45 Gross Charge Type: NIHD_Clinic_Price RT Aerosol Subsequent CHARGE 9464010 CDM 460 RC facility both 76 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price RT Aerosol Subsequent CHARGE 9464010 CDM 460 RC facility both 76 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price Sputum Induction 9464011 CDM 460 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price Sputum Induction 9464011 CDM 460 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price 94640 HHN INITIAL TREAMENT WITH AEROGEN Charge 946402 CDM 410 RC facility both 637 637 Gross Charge Type: NIHD_Hosp_Profee_Price 94640 HHN INITIAL TREAMENT WITH AEROGEN Charge 946402 CDM 410 RC facility both 637 637 Gross Charge Type: NIHD_Hosp_Profee_Price 94640 HHN INITIAL TREAMENT WITH AEROGEN ON VENTILATOR Charge 946403 CDM 410 RC facility both 621 621 Gross Charge Type: NIHD_Hosp_Profee_Price 94640 HHN INITIAL TREAMENT WITH AEROGEN ON VENTILATOR Charge 946403 CDM 410 RC facility both 621 621 Gross Charge Type: NIHD_Hosp_Profee_Price 94640 HHN INITIAL TREAMENT WITH METANEB Charge 946404 CDM 410 RC facility both 752 752 Gross Charge Type: NIHD_Hosp_Profee_Price 94640 HHN INITIAL TREAMENT WITH METANEB Charge 946404 CDM 410 RC facility both 752 752 Gross Charge Type: NIHD_Hosp_Profee_Price RT EzPAP Initial CHARGE 946405 CDM 410 RC facility both 520 520 Gross Charge Type: NIHD_Hosp_Profee_Price RT EzPAP Initial CHARGE 946405 CDM 410 RC facility both 520 520 Gross Charge Type: NIHD_Hosp_Profee_Price RT EzPAP Subsequent CHARGE 946406 CDM 410 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price RT EzPAP Subsequent CHARGE 946406 CDM 410 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price RT Meter Dose Inhaler Initial CHARGE 946407 CDM 410 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price RT Meter Dose Inhaler Initial CHARGE 946407 CDM 410 RC facility both 307 307 Gross Charge Type: NIHD_Hosp_Profee_Price RT Meter Dose Inhaler Subsequent CHARGE 946408 CDM 410 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price RT Meter Dose Inhaler Subsequent CHARGE 946408 CDM 410 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price RT Aerosol Initial CHARGE 946409 CDM 460 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price RT Aerosol Initial CHARGE 946409 CDM 460 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price RT Continuous Neb Initial CHARGE 94644 CDM 410 RC facility both 1162 1162 Gross Charge Type: NIHD_Hosp_Profee_Price RT Continuous Neb Initial CHARGE 94644 CDM 410 RC facility both 1162 1162 Gross Charge Type: NIHD_Hosp_Profee_Price RT Continuous Neb Subsequent CHARGE 94645 CDM 412 RC facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price RT Continuous Neb Subsequent CHARGE 94645 CDM 412 RC facility both 1023 1023 Gross Charge Type: NIHD_Hosp_Profee_Price Ventilator Management Subsequent Day 94657 CDM 412 RC facility both 2894 2894 Gross Charge Type: NIHD_Hosp_Profee_Price Ventilator Management Subsequent Day 94657 CDM 412 RC facility both 2894 2894 Gross Charge Type: NIHD_Hosp_Profee_Price 94660 INFANT NASAL CPAP VIA NASAL PRONGS Charge 946601 CDM 410 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price 94660 INFANT NASAL CPAP VIA NASAL PRONGS Charge 946601 CDM 410 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price RT BiPAP Initial CHARGE 946602 CDM 410 RC facility both 4108 4108 Gross Charge Type: NIHD_Hosp_Profee_Price RT BiPAP Initial CHARGE 946602 CDM 410 RC facility both 4108 4108 Gross Charge Type: NIHD_Hosp_Profee_Price RT BiPAP Subsequent CHARGE 946604 CDM 410 RC facility both 2446 2446 Gross Charge Type: NIHD_Hosp_Profee_Price RT BiPAP Subsequent CHARGE 946604 CDM 410 RC facility both 2446 2446 Gross Charge Type: NIHD_Hosp_Profee_Price RT CPAP Initial CHARGE 946605 CDM 412 RC facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price RT CPAP Initial CHARGE 946605 CDM 412 RC facility both 1225 1225 Gross Charge Type: NIHD_Hosp_Profee_Price RT CPAP Subsequent CHARGE 946606 CDM 412 RC facility both 987 987 Gross Charge Type: NIHD_Hosp_Profee_Price RT CPAP Subsequent CHARGE 946606 CDM 412 RC facility both 987 987 Gross Charge Type: NIHD_Hosp_Profee_Price "94664 Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer" 946641 CDM 521 RC 94664 HCPCS facility both 45 45 Gross Charge Type: NIHD_RHC_Price "94664 Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer" 946641 CDM 521 RC 94664 HCPCS facility both 45 45 Gross Charge Type: NIHD_Clinic_Price RT Aerosol Therapy Instruction CHARGE 946642 CDM 412 RC facility both 427 427 Gross Charge Type: NIHD_Hosp_Profee_Price RT Aerosol Therapy Instruction CHARGE 946642 CDM 412 RC facility both 427 427 Gross Charge Type: NIHD_Hosp_Profee_Price RT Meter Dose Inhaler Instruction CHARGE 946643 CDM 410 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price RT Meter Dose Inhaler Instruction CHARGE 946643 CDM 410 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price RT Flutter Therapy Initial CHARGE 946644 CDM 410 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price RT Flutter Therapy Initial CHARGE 946644 CDM 410 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price RT CPT Initial CHARGE 94667 CDM 410 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price RT CPT Initial CHARGE 94667 CDM 410 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price RT CPT Subsequent CHARGE 94668 CDM 410 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price RT CPT Subsequent CHARGE 94668 CDM 410 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price 94669 MetaNeb INITIAL CHARGE 946691 CDM 410 RC facility both 445 445 Gross Charge Type: NIHD_Hosp_Profee_Price 94669 MetaNeb INITIAL CHARGE 946691 CDM 410 RC facility both 445 445 Gross Charge Type: NIHD_Hosp_Profee_Price 94669 METANEB THERAPY SUBSEQUENT CHARGE 946692 CDM 410 RC facility both 244 244 Gross Charge Type: NIHD_Hosp_Profee_Price 94669 METANEB THERAPY SUBSEQUENT CHARGE 946692 CDM 410 RC facility both 244 244 Gross Charge Type: NIHD_Hosp_Profee_Price Hgb Fractionation Cascade LC 9468716 CDM 301 RC facility both 9.16 9.16 Gross Charge Type: NIHD_Hosp_Profee_Price Hgb Fractionation Cascade LC 9468716 CDM 301 RC facility both 9.16 9.16 Gross Charge Type: NIHD_Hosp_Profee_Price 94727 FUNCTIONAL RESIDUAL CAPACITY CHARGE 94727 CDM 460 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 94727 FUNCTIONAL RESIDUAL CAPACITY CHARGE 94727 CDM 460 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 94727 FRC-RV PROFEE 947271 CDM 982 RC 94727 HCPCS facility both 26 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 94727 FRC-RV PROFEE 947271 CDM 982 RC 94727 HCPCS facility both 26 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price RT Functional Residual Capacity CHARGE 947272 CDM 460 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price RT Functional Residual Capacity CHARGE 947272 CDM 460 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 94725 DIFUSSION CAPACITY CHARGE 94729 CDM 460 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 94725 DIFUSSION CAPACITY CHARGE 94729 CDM 460 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price 94729 DIFFUSION CAPACITY PRO FEE 947291 CDM 982 RC 94729 HCPCS facility both 26 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price 94729 DIFFUSION CAPACITY PRO FEE 947291 CDM 982 RC 94729 HCPCS facility both 26 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price RT Diffusion Capacity Weaning Charge 947292 CDM 460 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price RT Diffusion Capacity Weaning Charge 947292 CDM 460 RC facility both TC 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price Pulse Oximetry Clinic POC (RE) 94760 CDM 94760 HCPCS facility both 28 28 Gross Charge Type: NIHD_Clinic_Price 94760 Pulse Pximetry POC 947601 CDM 521 RC 94760 HCPCS facility both 29 29 Gross Charge Type: NIHD_RHC_Price 94760 Pulse Pximetry POC 947601 CDM 521 RC 94760 HCPCS facility both 28 28 Gross Charge Type: NIHD_Clinic_Price "RT POX, Single Determination CHARGE" 947602 CDM 410 RC facility both 182 182 Gross Charge Type: NIHD_Hosp_Profee_Price "RT POX, Single Determination CHARGE" 947602 CDM 410 RC facility both 182 182 Gross Charge Type: NIHD_Hosp_Profee_Price 94761 EXERCISE OXIMETRY CHARGE 94761 CDM 410 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price 94761 EXERCISE OXIMETRY CHARGE 94761 CDM 410 RC facility both 208 208 Gross Charge Type: NIHD_Hosp_Profee_Price 94799 Pulmonary Service/Negative inspiratory Force 94799 CDM 410 RC facility both 215 215 Gross Charge Type: NIHD_Hosp_Profee_Price 94799 Pulmonary Service/Negative inspiratory Force 94799 CDM 410 RC facility both 215 215 Gross Charge Type: NIHD_Hosp_Profee_Price "95004 - Percutaneous tests w/ allergenic extracts, includes interp/report, specify number of tests" 95004 CDM 521 RC 95004 HCPCS facility both 18 18 Gross Charge Type: NIHD_Clinic_Price "95017 Allergy testing, percutaneous & intracutaneous/intradermal w/ venoms,(sr/pun/prick specify #)" 95017 CDM 521 RC 95017 HCPCS facility both 28 28 Gross Charge Type: NIHD_RHC_Price "95017 Allergy testing, percutaneous & intracutaneous/intradermal w/ venoms,(sr/pun/prick specify #)" 95017 CDM 521 RC 95017 HCPCS facility both 28 28 Gross Charge Type: NIHD_Clinic_Price "95018 Allergy testing, percutaneous (scr/punct/prick) & intracutaneous w/ drugs or biologicals" 95018 CDM 521 RC 95018 HCPCS facility both 40 40 Gross Charge Type: NIHD_RHC_Price "95018 Allergy testing, percutaneous (scr/punct/prick) & intracutaneous w/ drugs or biologicals" 95018 CDM 521 RC 95018 HCPCS facility both 40 40 Gross Charge Type: NIHD_Clinic_Price "95024 Intracutaneous tests w/allergenic extracts, immediate reac, specify number of tests" 95024 CDM 521 RC 95024 HCPCS facility both 28 28 Gross Charge Type: NIHD_Clinic_Price 95076 Ingestion challenge test; initial 120 minutes (sequential&incremental ingestion of test items) 95076 CDM 521 RC 95076 HCPCS facility both 218 218 Gross Charge Type: NIHD_RHC_Price 95076 Ingestion challenge test; initial 120 minutes (sequential&incremental ingestion of test items) 95076 CDM 521 RC 95076 HCPCS facility both 218 218 Gross Charge Type: NIHD_Clinic_Price 95115 Professional Services for allergen immunotherapy single injection 95115 CDM 521 RC 95115 HCPCS facility both 38 38 Gross Charge Type: NIHD_RHC_Price 95115 Professional Services for allergen immunotherapy single injection 95115 CDM 521 RC 95115 HCPCS facility both 38 38 Gross Charge Type: NIHD_Clinic_Price 95117 Professional Services for allergen immunotherapy 2 or more injections 95117 CDM 521 RC 95117 HCPCS facility both 58 58 Gross Charge Type: NIHD_RHC_Price 95117 Professional Services for allergen immunotherapy 2 or more injections 95117 CDM 521 RC 95117 HCPCS facility both 57 57 Gross Charge Type: NIHD_Clinic_Price Allergy Injection POC - Multi 95117 CDM 520 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price Allergy Injection POC - Multi 95117 CDM 520 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price 95130 Services for allergen immunotherapy w/provision of allergenic extract; 1 sting insect venom 95130 CDM 521 RC 95130 HCPCS facility both 88 88 Gross Charge Type: NIHD_Clinic_Price 95132 Services for allergen immunotherapy w/provision of allergenic extract; 3 sting insect venoms 95132 CDM 521 RC 95132 HCPCS facility both 42 42 Gross Charge Type: NIHD_RHC_Price 95132 Services for allergen immunotherapy w/provision of allergenic extract; 3 sting insect venoms 95132 CDM 521 RC 95132 HCPCS facility both 42 42 Gross Charge Type: NIHD_Clinic_Price 95145 Preparation and provision of antigens for allergen immunotherapy; 1 sting insect venom 95145 CDM 521 RC 95145 HCPCS facility both 58 58 Gross Charge Type: NIHD_RHC_Price 95145 Preparation and provision of antigens for allergen immunotherapy; 1 sting insect venom 95145 CDM 521 RC 95145 HCPCS facility both 58 58 Gross Charge Type: NIHD_Clinic_Price 95165 - Preparation and provision of antigens for allergen immunotherapy; single or multiple antigen 95165 CDM 521 RC 95165 HCPCS facility both 22 22 Gross Charge Type: NIHD_Clinic_Price "Phospholipids, Serum LC" 9533749 CDM 300 RC facility both 7.46 7.46 Gross Charge Type: NIHD_Hosp_Profee_Price "Phospholipids, Serum LC" 9533749 CDM 300 RC facility both 7.46 7.46 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin D, Quant, Serum LC" 9533750 CDM 301 RC facility both 10.34 10.34 Gross Charge Type: NIHD_Hosp_Profee_Price "Immunoglobulin D, Quant, Serum LC" 9533750 CDM 301 RC facility both 10.34 10.34 Gross Charge Type: NIHD_Hosp_Profee_Price "Epstein-Barr DNA Quant, PCR LC" 9533767 CDM 301 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price "Epstein-Barr DNA Quant, PCR LC" 9533767 CDM 301 RC facility both 55 55 Gross Charge Type: NIHD_Hosp_Profee_Price "N-Telopeptide, Serum LC" 9533773 CDM 301 RC facility both 26.88 26.88 Gross Charge Type: NIHD_Hosp_Profee_Price "N-Telopeptide, Serum LC" 9533773 CDM 301 RC facility both 26.88 26.88 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Glycoprotein I Ab, IgG LC" 9533777 CDM 301 RC facility both 4.07 4.07 Gross Charge Type: NIHD_Hosp_Profee_Price "Beta-2 Glycoprotein I Ab, IgG LC" 9533777 CDM 301 RC facility both 4.07 4.07 Gross Charge Type: NIHD_Hosp_Profee_Price Tetanus Antitoxoid IgG Ab LC 9533780 CDM 301 RC facility both 7.33 7.33 Gross Charge Type: NIHD_Hosp_Profee_Price Tetanus Antitoxoid IgG Ab LC 9533780 CDM 301 RC facility both 7.33 7.33 Gross Charge Type: NIHD_Hosp_Profee_Price Lupus Anticoagulant Panel LC 9533799 CDM 300 RC facility both 274.3 274.3 Gross Charge Type: NIHD_Hosp_Profee_Price Lupus Anticoagulant Panel LC 9533799 CDM 300 RC facility both 274.3 274.3 Gross Charge Type: NIHD_Hosp_Profee_Price "Salivary Cortisol x4, Timed LC" 9533801 CDM 301 RC facility both 123.8 123.8 Gross Charge Type: NIHD_Hosp_Profee_Price "Salivary Cortisol x4, Timed LC" 9533801 CDM 301 RC facility both 123.8 123.8 Gross Charge Type: NIHD_Hosp_Profee_Price Pneumococcal Ab (23 Serotype) LC 9533812 CDM 301 RC facility both 62.95 62.95 Gross Charge Type: NIHD_Hosp_Profee_Price Pneumococcal Ab (23 Serotype) LC 9533812 CDM 301 RC facility both 62.95 62.95 Gross Charge Type: NIHD_Hosp_Profee_Price Pneumococcal IM (14 Serotype) LC 9533813 CDM 301 RC facility both 23.1 23.1 Gross Charge Type: NIHD_Hosp_Profee_Price Pneumococcal IM (14 Serotype) LC 9533813 CDM 301 RC facility both 23.1 23.1 Gross Charge Type: NIHD_Hosp_Profee_Price Hypersensitivity Pneumonitis LC 9533863 CDM 300 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price Hypersensitivity Pneumonitis LC 9533863 CDM 300 RC facility both 125 125 Gross Charge Type: NIHD_Hosp_Profee_Price Adalimumab Drug + Antibody LC 9533868 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price Adalimumab Drug + Antibody LC 9533868 CDM 301 RC facility both 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price BRCAssure BRCA1 and BRCA2 Comprehensive Analysis LC 9583101 CDM 300 RC facility both 1500 1500 Gross Charge Type: NIHD_Hosp_Profee_Price BRCAssure BRCA1 and BRCA2 Comprehensive Analysis LC 9583101 CDM 300 RC facility both 1500 1500 Gross Charge Type: NIHD_Hosp_Profee_Price ROM Each Extremity/Trunk Charges 95851 CDM 430 RC facility both GO 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price ROM Each Extremity/Trunk Charges 95851 CDM 430 RC facility both GO 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price ROM Hand Charges 95852 CDM 430 RC facility both GO 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price ROM Hand Charges 95852 CDM 430 RC facility both GO 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price "95885 Needle electromyography, each extremity; limited" 95885 CDM 521 RC 95885 HCPCS facility both 221 221 Gross Charge Type: NIHD_RHC_Price "95885 Needle electromyography, each extremity; limited" 95885 CDM 521 RC 95885 HCPCS facility both 221 221 Gross Charge Type: NIHD_Clinic_Price NITRONOX GAS PER HOUR CHARGE 9590942 CDM 270 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price NITRONOX GAS PER HOUR CHARGE 9590942 CDM 270 RC facility both 49 49 Gross Charge Type: NIHD_Hosp_Profee_Price 95972 Electronic analysis COMPLEX SPINAL CORD/PERIPHERAL neurostimulator; w/ program 95972 CDM 982 RC 95972 HCPCS facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price 95972 Electronic analysis COMPLEX SPINAL CORD/PERIPHERAL neurostimulator; w/ program 95972 CDM 982 RC 95972 HCPCS facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price PT Canalith Repositioning Charge 95992 CDM 420 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price PT Canalith Repositioning Charge 95992 CDM 420 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price PT Canalith Repositioning Charge 959921 CDM 420 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price PT Canalith Repositioning Charge 959921 CDM 420 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 95992 CANALITH REPOSITIONING PROCEDURE TechFee 959922 CDM 450 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 95992 CANALITH REPOSITIONING PROCEDURE TechFee 959922 CDM 450 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 95992 CANALITH REPOSITIONING PROCEDURE ProFee 959923 CDM 982 RC 95992 HCPCS facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price 95992 CANALITH REPOSITIONING PROCEDURE ProFee 959923 CDM 982 RC 95992 HCPCS facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price "96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/fa" 96040 CDM 521 RC 96040 HCPCS facility both 84 84 Gross Charge Type: NIHD_RHC_Price "96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/fa" 96040 CDM 521 RC 96040 HCPCS facility both 84 84 Gross Charge Type: NIHD_Clinic_Price 96105 ASSESS OF APHASIA W I&R PER HR 961051 CDM 982 RC 96105 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 96105 ASSESS OF APHASIA W I&R PER HR 961051 CDM 982 RC 96105 HCPCS facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 96105 ASSESS OF APHASIA W I&R PER HR CHARGE 961052 CDM 444 RC facility both GN 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 96105 ASSESS OF APHASIA W I&R PER HR CHARGE 961052 CDM 444 RC facility both GN 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price "96110 Developmental screening, with scoring and documentation, per standardized instrument" 96110 CDM 521 RC 96110 HCPCS facility both 128 128 Gross Charge Type: NIHD_RHC_Price "96110 Developmental screening, with scoring and documentation, per standardized instrument" 96110 CDM 521 RC 96110 HCPCS facility both 125 125 Gross Charge Type: NIHD_Clinic_Price 96112 DEVELOPMENTAL TESTNG; LTD 961121 CDM 982 RC 96112 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 96112 DEVELOPMENTAL TESTNG; LTD 961121 CDM 982 RC 96112 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 96112 DEVELOPMENTAL TESTING; LTD CHARGE 961122 CDM 440 RC facility both GN 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 96112 DEVELOPMENTAL TESTING; LTD CHARGE 961122 CDM 440 RC facility both GN 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 96113 DEVELOPMENTAL TESTING EACH ADDL 30 MINUTES 96113 CDM 440 RC facility both GN 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 96113 DEVELOPMENTAL TESTING EACH ADDL 30 MINUTES 96113 CDM 440 RC facility both GN 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price "96116 Neurobehavioral status exam, per hour, w/ interpretation and report" 96116 CDM 521 RC 96116 HCPCS facility both 173 173 Gross Charge Type: NIHD_RHC_Price "96116 Neurobehavioral status exam, per hour, w/ interpretation and report" 96116 CDM 521 RC 96116 HCPCS facility both 173 173 Gross Charge Type: NIHD_Clinic_Price 96125 Standardized cognitive performance testing per hour of a qualified health care professional's 96125 CDM 521 RC 96125 HCPCS facility both 196 196 Gross Charge Type: NIHD_RHC_Price 96125 Standardized cognitive performance testing per hour of a qualified health care professional's 96125 CDM 521 RC 96125 HCPCS facility both 196 196 Gross Charge Type: NIHD_Clinic_Price 96125 COGNITIVE TEST (MVPT ACL) CHARGE 961251 CDM 430 RC facility both GO 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 96125 COGNITIVE TEST (MVPT ACL) CHARGE 961251 CDM 430 RC facility both GO 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 96125 STANDARIZED COGNITIVE TESTING 961252 CDM 982 RC 96125 HCPCS facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price 96125 STANDARIZED COGNITIVE TESTING 961252 CDM 982 RC 96125 HCPCS facility both 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price 96125 - Std Cognigative Performance Test 961253 CDM 521 RC 96125 HCPCS facility both 196 196 Gross Charge Type: NIHD_RHC_Price 96125 - Std Cognigative Performance Test 961253 CDM 521 RC 96125 HCPCS facility both 196 196 Gross Charge Type: NIHD_Clinic_Price 96125 STANDARDIZED COGNITIVE TESTING CHARGE 961254 CDM 440 RC facility both GN 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price 96125 STANDARDIZED COGNITIVE TESTING CHARGE 961254 CDM 440 RC facility both GN 201 201 Gross Charge Type: NIHD_Hosp_Profee_Price 96125 COGNITIVE TEST (MVPT ACL) CHARGE 961255 CDM 430 RC facility both GO 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 96125 COGNITIVE TEST (MVPT ACL) CHARGE 961255 CDM 430 RC facility both GO 389 389 Gross Charge Type: NIHD_Hosp_Profee_Price 96127 Brief emotional behavioral assessment 96127 CDM 521 RC 96127 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price 96127 Brief emotional behavioral assessment 96127 CDM 521 RC 96127 HCPCS facility both 12 12 Gross Charge Type: NIHD_Clinic_Price 96130 Psychological testing evaluation services by physician or other qualified health care professi 96130 CDM 521 RC 96130 HCPCS facility both 212 212 Gross Charge Type: NIHD_RHC_Price 96130 Psychological testing evaluation services by physician or other qualified health care professi 96130 CDM 521 RC 96130 HCPCS facility both 212 212 Gross Charge Type: NIHD_Clinic_Price 96131 Psychological testing evaluation services by physician or other qualified health care professi 96131 CDM 521 RC 96131 HCPCS facility both 162 162 Gross Charge Type: NIHD_RHC_Price 96131 Psychological testing evaluation services by physician or other qualified health care professi 96131 CDM 521 RC 96131 HCPCS facility both 162 162 Gross Charge Type: NIHD_Clinic_Price 96132 Neuropsychological testing evaluation services by physician or other qualified health care pro 96132 CDM 521 RC 96132 HCPCS facility both 236 236 Gross Charge Type: NIHD_RHC_Price 96132 Neuropsychological testing evaluation services by physician or other qualified health care pro 96132 CDM 521 RC 96132 HCPCS facility both 236 236 Gross Charge Type: NIHD_Clinic_Price 96133 Neuropsychological testing evaluation services by physician or other qualified health care pro 96133 CDM 521 RC 96133 HCPCS facility both 178 178 Gross Charge Type: NIHD_RHC_Price 96133 Neuropsychological testing evaluation services by physician or other qualified health care pro 96133 CDM 521 RC 96133 HCPCS facility both 178 178 Gross Charge Type: NIHD_Clinic_Price 96137 Psychological or neuropsychological test administration and scoring by physician or other qual 96137 CDM 521 RC 96137 HCPCS facility both 79 79 Gross Charge Type: NIHD_RHC_Price 96137 Psychological or neuropsychological test administration and scoring by physician or other qual 96137 CDM 521 RC 96137 HCPCS facility both 79 79 Gross Charge Type: NIHD_Clinic_Price "96156 Health behavior assessment, or re-assessment" 961561 CDM 521 RC 96156 HCPCS facility both 173 173 Gross Charge Type: NIHD_RHC_Price "96156 Health behavior assessment, or re-assessment" 961561 CDM 521 RC 96156 HCPCS facility both 173 173 Gross Charge Type: NIHD_Clinic_Price "96156- Health behavior assessment, or re-assessment" 961562 CDM 521 RC 96156 HCPCS facility both 173 173 Gross Charge Type: NIHD_RHC_Price "96156- Health behavior assessment, or re-assessment" 961562 CDM 521 RC 96156 HCPCS facility both 173 173 Gross Charge Type: NIHD_Clinic_Price "96158 Health behavior intervention, individual, face-to-face; init" 961581 CDM 521 RC 96158 HCPCS facility both 118 118 Gross Charge Type: NIHD_RHC_Price "96158 Health behavior intervention, individual, face-to-face; init" 961581 CDM 521 RC 96158 HCPCS facility both 118 118 Gross Charge Type: NIHD_Clinic_Price "96158 Health behavior intervention, individual, face-to-face; initial 30 minutes" 961582 CDM 521 RC 96158 HCPCS facility both 118 118 Gross Charge Type: NIHD_RHC_Price "96158 Health behavior intervention, individual, face-to-face; initial 30 minutes" 961582 CDM 521 RC 96158 HCPCS facility both 118 118 Gross Charge Type: NIHD_Clinic_Price "96159 Health behavior intervention, individual, face-to-face; each" 961591 CDM 521 RC 96159 HCPCS facility both 42 42 Gross Charge Type: NIHD_RHC_Price "96159 Health behavior intervention, individual, face-to-face; each" 961591 CDM 521 RC 96159 HCPCS facility both 42 42 Gross Charge Type: NIHD_Clinic_Price "96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separ" 961592 CDM 521 RC 96159 HCPCS facility both 42 42 Gross Charge Type: NIHD_RHC_Price "96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separ" 961592 CDM 521 RC 96159 HCPCS facility both 42 42 Gross Charge Type: NIHD_Clinic_Price 96160 Administer depression screening 96160 CDM 521 RC 96160 HCPCS facility both 6 6 Gross Charge Type: NIHD_RHC_Price 96160 Administer depression screening 96160 CDM 521 RC 96160 HCPCS facility both 6 6 Gross Charge Type: NIHD_Clinic_Price 96161 Administration of health risk assessment instrument 96161 CDM 521 RC 96161 HCPCS facility both 9 9 Gross Charge Type: NIHD_RHC_Price 96161 Administration of health risk assessment instrument 96161 CDM 521 RC 96161 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price "96164 Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes" 96164 CDM 521 RC 96164 HCPCS facility both 20 20 Gross Charge Type: NIHD_RHC_Price "96164 Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes" 96164 CDM 521 RC 96164 HCPCS facility both 20 20 Gross Charge Type: NIHD_Clinic_Price "96165 Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 min" 96165 CDM 521 RC 96165 HCPCS facility both 9 9 Gross Charge Type: NIHD_RHC_Price "96165 Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 min" 96165 CDM 521 RC 96165 HCPCS facility both 9 9 Gross Charge Type: NIHD_Clinic_Price "96167 Health behavior intervention, family (with the patient prese" 961671 CDM 521 RC 96167 HCPCS facility both 127 127 Gross Charge Type: NIHD_RHC_Price "96167 Health behavior intervention, family (with the patient prese" 961671 CDM 521 RC 96167 HCPCS facility both 127 127 Gross Charge Type: NIHD_Clinic_Price "96167 Health behavior intervention, family (with the patient present), face-to-face; initial 30 min" 961672 CDM 521 RC 96167 HCPCS facility both 127 127 Gross Charge Type: NIHD_RHC_Price "96167 Health behavior intervention, family (with the patient present), face-to-face; initial 30 min" 961672 CDM 521 RC 96167 HCPCS facility both 127 127 Gross Charge Type: NIHD_Clinic_Price "96168 Health behavior intervention, family (with the patient prese" 961681 CDM 521 RC 96168 HCPCS facility both 45 45 Gross Charge Type: NIHD_RHC_Price "96168 Health behavior intervention, family (with the patient prese" 961681 CDM 521 RC 96168 HCPCS facility both 45 45 Gross Charge Type: NIHD_Clinic_Price "96168 Health behavior intervention, family (with the patient present), face-to-face; each additional" 961682 CDM 521 RC 96168 HCPCS facility both 45 45 Gross Charge Type: NIHD_RHC_Price "96168 Health behavior intervention, family (with the patient present), face-to-face; each additional" 961682 CDM 521 RC 96168 HCPCS facility both 45 45 Gross Charge Type: NIHD_Clinic_Price "96170 Health behavior intervention, family (without the patient pr" 961701 CDM 521 RC 96170 HCPCS facility both 142 142 Gross Charge Type: NIHD_RHC_Price "96170 Health behavior intervention, family (without the patient pr" 961701 CDM 521 RC 96170 HCPCS facility both 142 142 Gross Charge Type: NIHD_Clinic_Price "96170 Health Behavior Intervention, Family (w/o patient present), Face-to-Face, First 30 Minutes" 961702 CDM 521 RC 96170 HCPCS facility both 142 142 Gross Charge Type: NIHD_RHC_Price "96170 Health Behavior Intervention, Family (w/o patient present), Face-to-Face, First 30 Minutes" 961702 CDM 521 RC 96170 HCPCS facility both 142 142 Gross Charge Type: NIHD_Clinic_Price "96171 Health behavior intervention, family (without the patient pr" 961711 CDM 521 RC 96171 HCPCS facility both 53 53 Gross Charge Type: NIHD_RHC_Price "96171 Health behavior intervention, family (without the patient pr" 961711 CDM 521 RC 96171 HCPCS facility both 53 53 Gross Charge Type: NIHD_Clinic_Price "96171 Health Behavior Intervention, Family (w/o patient present), Face-to-Face; Each Additional 15 M" 961712 CDM 521 RC 96171 HCPCS facility both 53 53 Gross Charge Type: NIHD_RHC_Price "96171 Health Behavior Intervention, Family (w/o patient present), Face-to-Face; Each Additional 15 M" 961712 CDM 521 RC 96171 HCPCS facility both 53 53 Gross Charge Type: NIHD_Clinic_Price IOL TECNIS MF ZMB00 10.0 1 PIECE 9620010 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TECNIS MF ZMB00 10.0 1 PIECE 9620010 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price "96360 - ED Hydration, first hour" 963601 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "96360 - ED Hydration, first hour" 963601 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "96360 INTRAVENOUS INFUSION, HYDRATION TechFee" 963602 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "96360 INTRAVENOUS INFUSION, HYDRATION TechFee" 963602 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 96360 HYDRATION INFUSION >30 TO 90 MINS Charge 963603 CDM 260 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 96360 HYDRATION INFUSION >30 TO 90 MINS Charge 963603 CDM 260 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price "96361- ED Hydration, each additional hour" 963611 CDM 450 RC facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price "96361- ED Hydration, each additional hour" 963611 CDM 450 RC facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price "96361 INTRAVENOUS INFUSION, HYDRATION TechFee" 963612 CDM 450 RC facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price "96361 INTRAVENOUS INFUSION, HYDRATION TechFee" 963612 CDM 450 RC facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price 96361 HYDRATION IV EA ADD<=8 HR Charge 963613 CDM 260 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price 96361 HYDRATION IV EA ADD<=8 HR Charge 963613 CDM 260 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price "96365- ED IV tx, first hour" 963651 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "96365- ED IV tx, first hour" 963651 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "96365 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS TechFee" 963652 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "96365 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS TechFee" 963652 CDM 450 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 96365 Iv Infusion Therapy / Prophlaxis 1st - 1 hr of Infusion 963653 CDM 260 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 96365 Iv Infusion Therapy / Prophlaxis 1st - 1 hr of Infusion 963653 CDM 260 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 96366 - IV INFUSION NON-HYDRATION EACH ADDITIONAL HOUR 96366 CDM 260 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 96366 - IV INFUSION NON-HYDRATION EACH ADDITIONAL HOUR 96366 CDM 260 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "96366- ED IV tx, each additional hour" 963661 CDM 450 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "96366- ED IV tx, each additional hour" 963661 CDM 450 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "96366 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS TechFee" 963662 CDM 450 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "96366 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS TechFee" 963662 CDM 450 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 96366 IV INFUSION EA ADD<=8 HR Charge 963663 CDM 260 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 96366 IV INFUSION EA ADD<=8 HR Charge 963663 CDM 260 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 96367 ADDL SEQUENT INFUSION CHARGE 96367 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 96367 ADDL SEQUENT INFUSION CHARGE 96367 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "96367- ED IV tx, sequential infusion" 963671 CDM 450 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "96367- ED IV tx, sequential infusion" 963671 CDM 450 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "96367 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS TechFee" 963672 CDM 450 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "96367 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS TechFee" 963672 CDM 450 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 96367 INFUSION THRP/PROPH EA SEQUENT Charge 963673 CDM 260 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 96367 INFUSION THRP/PROPH EA SEQUENT Charge 963673 CDM 260 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 96368 INFUSION IV CONCURRENT EACH HR Charge 96368 CDM 260 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price 96368 INFUSION IV CONCURRENT EACH HR Charge 96368 CDM 260 RC facility both 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price "96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular:" 963721 CDM 521 RC 96372 HCPCS facility both 14 14 Gross Charge Type: NIHD_RHC_Price "96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular:" 963721 CDM 521 RC 96372 HCPCS facility both 40 40 Gross Charge Type: NIHD_Clinic_Price 96372- ED Subq/IM Injection 963722 CDM 450 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 96372- ED Subq/IM Injection 963722 CDM 450 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 96372 IM SC Injection Each TechFee 963723 CDM 450 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 96372 IM SC Injection Each TechFee 963723 CDM 450 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 96372 INJECT IM/SQ Charge 963724 CDM 260 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 96372 INJECT IM/SQ Charge 963724 CDM 260 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 96372 INJ IM/SUB THERAPUTIC/DIAGNOS ProFee 963725 CDM 982 RC 96372 HCPCS facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price 96372 INJ IM/SUB THERAPUTIC/DIAGNOS ProFee 963725 CDM 982 RC 96372 HCPCS facility both 45 45 Gross Charge Type: NIHD_Hosp_Profee_Price "96374 Therapeutic, prophylactic, or diagnostic injection; IV push, single or initial substance/drug" 963741 CDM 521 RC 96374 HCPCS facility both 114 114 Gross Charge Type: NIHD_RHC_Price "96374 Therapeutic, prophylactic, or diagnostic injection; IV push, single or initial substance/drug" 963741 CDM 521 RC 96374 HCPCS facility both 119 119 Gross Charge Type: NIHD_Clinic_Price "96374-Injection, single/initial" 963742 CDM 450 RC facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "96374-Injection, single/initial" 963742 CDM 450 RC facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "96374 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION TechFee" 963743 CDM 450 RC facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price "96374 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION TechFee" 963743 CDM 450 RC facility both 363 363 Gross Charge Type: NIHD_Hosp_Profee_Price 96374 INJECT IV INITIAL Charge 963744 CDM 260 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 96374 INJECT IV INITIAL Charge 963744 CDM 260 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 96374 OBS IV PUSH SING/INITIAL ProFee 963745 CDM 982 RC 96374 HCPCS facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price 96374 OBS IV PUSH SING/INITIAL ProFee 963745 CDM 982 RC 96374 HCPCS facility both 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price "96375 Therapeutic, prophylactic, or diagnostic injection; ea add IV push of a new substance/drug" 963751 CDM 521 RC 96375 HCPCS facility both 59 59 Gross Charge Type: NIHD_RHC_Price "96375-IV Injection, add new drug" 963752 CDM 450 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "96375-IV Injection, add new drug" 963752 CDM 450 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "96375 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION ED" 963753 CDM 450 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "96375 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION ED" 963753 CDM 450 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 96375 INJECTION NEW DRUG TX; PRO; DX Charge 963754 CDM 260 RC facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price 96375 INJECTION NEW DRUG TX; PRO; DX Charge 963754 CDM 260 RC facility both 229 229 Gross Charge Type: NIHD_Hosp_Profee_Price "96376- ED IV Injection, add same drug" 963761 CDM 450 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "96376- ED IV Injection, add same drug" 963761 CDM 450 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "96376 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION TechFee" 963762 CDM 450 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "96376 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION TechFee" 963762 CDM 450 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price 96376 INJECTION SAME DRUG SEQ TX; PRO; DX Charge 963763 CDM 260 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price 96376 INJECTION SAME DRUG SEQ TX; PRO; DX Charge 963763 CDM 260 RC facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price 96377 APP ON BODY INJECTOR CHARGE 96377 CDM 761 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price 96377 APP ON BODY INJECTOR CHARGE 96377 CDM 761 RC facility both 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price 96380 ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP 96380 CDM 771 RC 96380 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price 96380 ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP 96380 CDM 771 RC 96380 HCPCS facility both 101 101 Gross Charge Type: NIHD_Clinic_Price 96380 VFC ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP 963801 CDM 771 RC 96380 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price 96380 VFC ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP 963801 CDM 771 RC 96380 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price 96381 ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX 96381 CDM 771 RC 96381 HCPCS facility both 96 96 Gross Charge Type: NIHD_RHC_Price 96381 ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX 96381 CDM 771 RC 96381 HCPCS facility both 101 101 Gross Charge Type: NIHD_Clinic_Price 96381 VFC ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX 963811 CDM 771 RC 96381 HCPCS facility both 10 10 Gross Charge Type: NIHD_RHC_Price 96381 VFC ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX 963811 CDM 771 RC 96381 HCPCS facility both 10 10 Gross Charge Type: NIHD_Clinic_Price 96401 CHEMO ADMIN NON HORMONAL SQ/IM CHARGE 96401 CDM 331 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 96401 CHEMO ADMIN NON HORMONAL SQ/IM CHARGE 96401 CDM 331 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 96402 CHEMO ADMIN HORMONAL SQ/IM CHARGE 96402 CDM 331 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 96402 CHEMO ADMIN HORMONAL SQ/IM CHARGE 96402 CDM 331 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 96409 CHEMO IV PUSH/15 MIN INFUSION CHARGES 96409 CDM 335 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price 96409 CHEMO IV PUSH/15 MIN INFUSION CHARGES 96409 CDM 335 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price 96411 CHEMO SEQUENTIAL IV PUSH/15 CHARGE 96411 CDM 335 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price 96411 CHEMO SEQUENTIAL IV PUSH/15 CHARGE 96411 CDM 335 RC facility both 326 326 Gross Charge Type: NIHD_Hosp_Profee_Price 96413 CHEMO ADMIN/INIT HR CHARGE 96413 CDM 335 RC facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price 96413 CHEMO ADMIN/INIT HR CHARGE 96413 CDM 335 RC facility both 1310 1310 Gross Charge Type: NIHD_Hosp_Profee_Price 96415 CHEMO INFUSION EACH ADDITIONAL HOUR CHARGE 96415 CDM 335 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 96415 CHEMO INFUSION EACH ADDITIONAL HOUR CHARGE 96415 CDM 335 RC facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 96417 ADD SEQUENTIAL CHEMO INFUSION CHARGE 96417 CDM 335 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 96417 ADD SEQUENTIAL CHEMO INFUSION CHARGE 96417 CDM 335 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 96521 REFILL/MAINT PORTABLE PUMP Charge 96521 CDM 761 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price 96521 REFILL/MAINT PORTABLE PUMP Charge 96521 CDM 761 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price 96523 FLUSH-IMPLATED ACCESS DEVICE CHARGE 96523 CDM 761 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price 96523 FLUSH-IMPLATED ACCESS DEVICE CHARGE 96523 CDM 761 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price 96549 UNLISTED CHEMO PROCEDURE CHARGE 96549 CDM 335 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 96549 UNLISTED CHEMO PROCEDURE CHARGE 96549 CDM 335 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Hot/Cold Pack Application Charge 970101 CDM 430 RC facility both GO 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Hot/Cold Pack Application Charge 970101 CDM 430 RC facility both GO 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Other Thermal Charge 970102 CDM 420 RC facility both GP 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Other Thermal Charge 970102 CDM 420 RC facility both GP 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price Manual Traction Charge 97012 CDM 420 RC facility both GP 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price Manual Traction Charge 97012 CDM 420 RC facility both GP 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price OT Unattended Electrical Therapy Charge 970141 CDM 430 RC facility both GO 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price OT Unattended Electrical Therapy Charge 970141 CDM 430 RC facility both GO 116 116 Gross Charge Type: NIHD_Hosp_Profee_Price PT Unattended E-Stim Assistant Units 970142 CDM 420 RC facility both GP 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price PT Unattended E-Stim Assistant Units 970142 CDM 420 RC facility both GP 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price OT Paraffin Bath Charge 970181 CDM 430 RC facility both GO 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price OT Paraffin Bath Charge 970181 CDM 430 RC facility both GO 107 107 Gross Charge Type: NIHD_Hosp_Profee_Price Paraffin Bath Charge 970183 CDM 420 RC facility both GP 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price Paraffin Bath Charge 970183 CDM 420 RC facility both GP 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price Paraffin Bath Charge 970184 CDM 420 RC facility both GP 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price Paraffin Bath Charge 970184 CDM 420 RC facility both GP 94 94 Gross Charge Type: NIHD_Hosp_Profee_Price "PT Whirlpool, Fluidotherapy Units" 970221 CDM 420 RC facility both GP 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "PT Whirlpool, Fluidotherapy Units" 970221 CDM 420 RC facility both GP 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 97022 EXTREMITY WHIRLPOOL CHARGE 970222 CDM 420 RC facility both GP 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price 97022 EXTREMITY WHIRLPOOL CHARGE 970222 CDM 420 RC facility both GP 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price Attended E-Stim Charges 970321 CDM 430 RC facility both GO 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Attended E-Stim Charges 970321 CDM 430 RC facility both GO 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price PT Attended E-Stim Assistant Units 970322 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price PT Attended E-Stim Assistant Units 970322 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price Attended E-Stim Charges 970323 CDM 430 RC facility both 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Attended E-Stim Charges 970323 CDM 430 RC facility both 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Iontophoresis Charges 970331 CDM 430 RC facility both GO 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price Iontophoresis Charges 970331 CDM 430 RC facility both GO 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price Iontophoresis Charges 970332 CDM 420 RC facility both GP 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price Iontophoresis Charges 970332 CDM 420 RC facility both GP 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price Iontophoresis Charges 970333 CDM 430 RC facility both GO 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price Iontophoresis Charges 970333 CDM 430 RC facility both GO 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price OT Contrast Bath Charges 97034 CDM 430 RC facility both GO 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price OT Contrast Bath Charges 97034 CDM 430 RC facility both GO 108 108 Gross Charge Type: NIHD_Hosp_Profee_Price Ultrasound Charges 970351 CDM 430 RC facility both GO 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Ultrasound Charges 970351 CDM 430 RC facility both GO 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price PT Ultrasound Assistant Units 970352 CDM 420 RC facility both GP 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price PT Ultrasound Assistant Units 970352 CDM 420 RC facility both GP 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Ultrasound Charges 970353 CDM 430 RC facility both GO 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Ultrasound Charges 970353 CDM 430 RC facility both GO 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price OT Therapeutic Exercise Charges 971101 CDM 430 RC facility both GO 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price OT Therapeutic Exercise Charges 971101 CDM 430 RC facility both GO 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price Therapeutic Exercise Charges 971102 CDM 420 RC facility both GP 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price Therapeutic Exercise Charges 971102 CDM 420 RC facility both GP 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price PT Therapeutic Exercise Assit Units 971103 CDM 420 RC facility both GPCO 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price PT Therapeutic Exercise Assit Units 971103 CDM 420 RC facility both GPCO 166 166 Gross Charge Type: NIHD_Hosp_Profee_Price 97110 OT THER EXERCISE 15 CHARGE 971105 CDM 430 RC facility both G0 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 97110 OT THER EXERCISE 15 CHARGE 971105 CDM 430 RC facility both G0 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price OT Neuromuscular Reeducation Charges 971121 CDM 430 RC facility both GO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price OT Neuromuscular Reeducation Charges 971121 CDM 430 RC facility both GO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price PT Neuromuscular Reeducation Assist Unit 971122 CDM 420 RC facility both GP 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Neuromuscular Reeducation Charges 971122 CDM 420 RC facility both GP 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Neuromuscular Reeducation Charges 971123 CDM 420 RC facility both GP 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price Neuromuscular Reeducation Charges 971123 CDM 420 RC facility both GP 134 134 Gross Charge Type: NIHD_Hosp_Profee_Price 97112 OT - NM REED 15 MIN 971125 CDM 430 RC facility both GO 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price 97112 OT - NM REED 15 MIN 971125 CDM 430 RC facility both GO 127 127 Gross Charge Type: NIHD_Hosp_Profee_Price PT Vasopneumatic Devices Assistant Units 97116 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price PT Vasopneumatic Devices Assistant Units 97116 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price Gait Training Charges 971161 CDM 430 RC facility both GP 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price Gait Training Charges 971161 CDM 430 RC facility both GP 138 138 Gross Charge Type: NIHD_Hosp_Profee_Price OT Massage Charge Units 971241 CDM 430 RC facility both GO 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price OT Massage Charge Units 971241 CDM 430 RC facility both GO 119 119 Gross Charge Type: NIHD_Hosp_Profee_Price PT Massage Assistant Units 971242 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price PT Massage Assistant Units 971242 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CHARGE 971291 CDM 430 RC facility both GO 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CHARGE 971291 CDM 430 RC facility both GO 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES 971292 CDM 982 RC 97129 HCPCS facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES 971292 CDM 982 RC 97129 HCPCS facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price SLP Cog Ther Intervent1st 15min Unit 971293 CDM 440 RC facility both GN 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price SLP Cog Ther Intervent1st 15min Unit 971293 CDM 440 RC facility both GN 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CHARGE 971294 CDM 440 RC facility both GN 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CHARGE 971294 CDM 440 RC facility both GN 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 97129 OT COGNITIVE FUNCTION; INITIAL 15 MIN CHARGE 971295 CDM 430 RC facility both GO 120 120 Gross Charge Type: NIHD_Hosp_Profee_Price 97129 OT COGNITIVE FUNCTION; INITIAL 15 MIN CHARGE 971295 CDM 430 RC facility both GO 120 120 Gross Charge Type: NIHD_Hosp_Profee_Price 97130 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CHARGE 971301 CDM 430 RC facility both GO 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 97130 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CHARGE 971301 CDM 430 RC facility both GO 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 97130 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES 971302 CDM 982 RC 97130 HCPCS facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price 97130 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES 971302 CDM 982 RC 97130 HCPCS facility both 42 42 Gross Charge Type: NIHD_Hosp_Profee_Price "SLP Cog Ther Intervent, Addl 15 Units" 971303 CDM 440 RC facility both GN 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price "SLP Cog Ther Intervent, Addl 15 Units" 971303 CDM 440 RC facility both GN 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 97130 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CHARGE 971304 CDM 440 RC facility both GN 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price 97130 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CHARGE 971304 CDM 440 RC facility both GN 115 115 Gross Charge Type: NIHD_Hosp_Profee_Price "97130 OT Cognitive Function, Addl. 15 min." 971305 CDM 430 RC facility both GO 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price "97130 OT Cognitive Function, Addl. 15 min." 971305 CDM 430 RC facility both GO 110 110 Gross Charge Type: NIHD_Hosp_Profee_Price OT Manual Therapy Charge Units 971401 CDM 430 RC facility both GO 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price OT Manual Therapy Charge Units 971401 CDM 430 RC facility both GO 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price PT Manual Therapy Assistant Units 971402 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price PT Manual Therapy Assistant Units 971402 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price "97140: Manual therapy techniques, 1 or more regions, each 15 minutes" 971405 CDM 430 RC facility both GO 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price "97140: Manual therapy techniques, 1 or more regions, each 15 minutes" 971405 CDM 430 RC facility both GO 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price Group Therapy Charge 97150 CDM 420 RC facility both GP 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price Group Therapy Charge 97150 CDM 420 RC facility both GP 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price "97156 Family adaptive behavior treatment guidance, administered by physician or other qualified heal" 97156 CDM 521 RC 97156 HCPCS facility both 402 402 Gross Charge Type: NIHD_RHC_Price "97156 Family adaptive behavior treatment guidance, administered by physician or other qualified heal" 97156 CDM 521 RC 97156 HCPCS facility both 402 402 Gross Charge Type: NIHD_Clinic_Price "97157 Multiple-family group adaptive behavior treatment guidance, administered by physician or other" 97157 CDM 521 RC 97157 HCPCS facility both 402 402 Gross Charge Type: NIHD_RHC_Price "97157 Multiple-family group adaptive behavior treatment guidance, administered by physician or other" 97157 CDM 521 RC 97157 HCPCS facility both 402 402 Gross Charge Type: NIHD_Clinic_Price PT Low Complex Units 97161 CDM 424 RC facility both GP 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price PT Low Complex Units 97161 CDM 424 RC facility both GP 164 164 Gross Charge Type: NIHD_Hosp_Profee_Price PT Moderate Complex Units 97162 CDM 424 RC facility both GP 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price PT Moderate Complex Units 97162 CDM 424 RC facility both GP 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price PT High Complex Units 97163 CDM 424 RC facility both GP 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price PT High Complex Units 97163 CDM 424 RC facility both GP 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price PT ReEval Units 97164 CDM 424 RC facility both GP 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price PT ReEval Units 97164 CDM 424 RC facility both GP 277 277 Gross Charge Type: NIHD_Hosp_Profee_Price OT Low Complex Units 97165 CDM 434 RC facility both GO 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price OT Low Complex Units 97165 CDM 434 RC facility both GO 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price "97165 OT EVAL, LOW COMPLEXITY" 971655 CDM 434 RC facility both GO 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price "97165 OT EVAL, LOW COMPLEXITY" 971655 CDM 434 RC facility both GO 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price OT Moderate Complex Units 97166 CDM 434 RC facility both GO 279 279 Gross Charge Type: NIHD_Hosp_Profee_Price OT Moderate Complex Units 97166 CDM 434 RC facility both GO 279 279 Gross Charge Type: NIHD_Hosp_Profee_Price "97166 OT EVAL, MOD COMPLEXITY" 971665 CDM 434 RC facility both GO 266 266 Gross Charge Type: NIHD_Hosp_Profee_Price "97166 OT EVAL, MOD COMPLEXITY" 971665 CDM 434 RC facility both GO 266 266 Gross Charge Type: NIHD_Hosp_Profee_Price OT High Complex Units 97167 CDM 434 RC facility both GO 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price OT High Complex Units 97167 CDM 434 RC facility both GO 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "97167 OT EVAL, HIGH COMPLEXITY" 971675 CDM 434 RC facility both GO 395 395 Gross Charge Type: NIHD_Hosp_Profee_Price "97167 OT EVAL, HIGH COMPLEXITY" 971675 CDM 434 RC facility both GO 395 395 Gross Charge Type: NIHD_Hosp_Profee_Price OT ReEval Units 97168 CDM 434 RC facility both GO 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price OT ReEval Units 97168 CDM 434 RC facility both GO 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price OT Therapeutic Activities Charges 975301 CDM 430 RC facility both GO 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price OT Therapeutic Activities Charges 975301 CDM 430 RC facility both GO 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price PT Therapeutic Activity Assistant Units 975302 CDM 420 RC facility both GP 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price PT Therapeutic Activity Assistant Units 975302 CDM 420 RC facility both GP 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 97530 OT Therapeutic Activities Charges 975305 CDM 430 RC facility both G0 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price 97530 OT Therapeutic Activities Charges 975305 CDM 430 RC facility both G0 159 159 Gross Charge Type: NIHD_Hosp_Profee_Price Sensory Stimulation Charge 975331 CDM 430 RC facility both GO 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Sensory Stimulation Charge 975331 CDM 430 RC facility both GO 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Sensory Stimulation Charge 975332 CDM 430 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price Sensory Stimulation Charge 975332 CDM 430 RC facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price ADL Training Charges 975351 CDM 430 RC facility both GO 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price ADL Training Charges 975351 CDM 430 RC facility both GO 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price "PT Self Care, Home Mgmt Assistant units" 975352 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price "PT Self Care, Home Mgmt Assistant units" 975352 CDM 420 RC facility both GPCO 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price OT ADL Training Charges 975353 CDM 430 RC facility both GO 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price OT ADL Training Charges 975353 CDM 430 RC facility both GO 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 97537 OCC ERGONOMIC CONSULT/15MIN CHARGE 97537 CDM 430 RC facility both 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price 97537 OCC ERGONOMIC CONSULT/15MIN CHARGE 97537 CDM 430 RC facility both 124 124 Gross Charge Type: NIHD_Hosp_Profee_Price Wheelchair Charge 97542 CDM 430 RC facility both GO 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price Wheelchair Charge 97542 CDM 430 RC facility both GO 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price Wheelchair and Seating Evaluation 975421 CDM 420 RC facility both GP 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price Wheelchair and Seating Evaluation 975421 CDM 420 RC facility both GP 146 146 Gross Charge Type: NIHD_Hosp_Profee_Price 97597 WOUND CARE 20CM OR < CHARGE 97597 CDM 761 RC facility both 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price 97597 WOUND CARE 20CM OR < CHARGE 97597 CDM 761 RC facility both 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price "97597 Debridement, open wound; first 20 sq cm or less" 975971 CDM 521 RC 97597 HCPCS facility both 281 281 Gross Charge Type: NIHD_RHC_Price "97597 Debridement, open wound; first 20 sq cm or less" 975971 CDM 521 RC 97597 HCPCS facility both 281 281 Gross Charge Type: NIHD_Clinic_Price PT Selective Debridement <20 Units 975972 CDM 420 RC facility both GP 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price PT Selective Debridement <20 Units 975972 CDM 420 RC facility both GP 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price 97597 WOUND DEBRIDEMENT ProFee 975973 CDM 982 RC 97597 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price 97597 WOUND DEBRIDEMENT ProFee 975973 CDM 982 RC 97597 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price 97597 DEBRIDEMENT OPEN WOUND <=20 SQ CM TechFee 975974 CDM 450 RC facility both 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price 97597 DEBRIDEMENT OPEN WOUND <=20 SQ CM TechFee 975974 CDM 450 RC facility both 517 517 Gross Charge Type: NIHD_Hosp_Profee_Price 97598 Debride Select Ea Addl 20cm Charges 97598_969 CDM 969 RC facility both 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price 97598 Debride Select Ea Addl 20cm Charges 97598_969 CDM 969 RC facility both 22 22 Gross Charge Type: NIHD_Hosp_Profee_Price 97598 DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF 97598_982 CDM 982 RC 97598 HCPCS facility both 23 23 Gross Charge Type: NIHD_Hosp_Profee_Price 97598 DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF 97598_982 CDM 982 RC 97598 HCPCS facility both 23 23 Gross Charge Type: NIHD_Hosp_Profee_Price 97598 DEBRIDE DEVIT TISS EA ADDTNL 975981 CDM 761 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price 97598 DEBRIDE DEVIT TISS EA ADDTNL 975981 CDM 761 RC facility both 426 426 Gross Charge Type: NIHD_Hosp_Profee_Price "97598 Debridement, open wound; each additional 20 sq cm, or part thereof" 975983 CDM 521 RC 97598 HCPCS facility both 71 71 Gross Charge Type: NIHD_RHC_Price "97598 Debridement, open wound; each additional 20 sq cm, or part thereof" 975983 CDM 521 RC 97598 HCPCS facility both 71 71 Gross Charge Type: NIHD_Clinic_Price 97602 ACTIVE WND MNGNT NON SEL DEBRID 97602 CDM 761 RC facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price 97602 ACTIVE WND MNGNT NON SEL DEBRID 97602 CDM 761 RC facility both 269 269 Gross Charge Type: NIHD_Hosp_Profee_Price "97602 Remove devitalized tissue from wound, non-selective debridement, w/o anesthesia, per session" 976021 CDM 521 RC 97602 HCPCS facility both 447 447 Gross Charge Type: NIHD_RHC_Price "97602 Remove devitalized tissue from wound, non-selective debridement, w/o anesthesia, per session" 976021 CDM 521 RC 97602 HCPCS facility both 447 447 Gross Charge Type: NIHD_Clinic_Price Non-Selective Debridement Charge 976023 CDM 420 RC facility both GP 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price Non-Selective Debridement Charge 976023 CDM 420 RC facility both GP 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price "97602 REMOVE DEVITALIZED TISSUE, NON-SELECT W/O ANES, INCL TOP APPL, WND ASMT/SESS ProFee" 976024 CDM 940 RC 97602 HCPCS facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price "97602 REMOVE DEVITALIZED TISSUE, NON-SELECT W/O ANES, INCL TOP APPL, WND ASMT/SESS ProFee" 976024 CDM 940 RC 97602 HCPCS facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price Wound Care Routine 97605_1 CDM 761 RC facility both 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price Wound Care Routine 97605_1 CDM 761 RC facility both 169 169 Gross Charge Type: NIHD_Hosp_Profee_Price Wound Care Routine 97605_2 CDM 761 RC facility both 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price Wound Care Routine 97605_2 CDM 761 RC facility both 435 435 Gross Charge Type: NIHD_Hosp_Profee_Price 97605 Negative pressure wound therapy; total wound(s) surface area less than or equal to 50 sq cm 976051 CDM 521 RC 97605 HCPCS facility both 89 89 Gross Charge Type: NIHD_Clinic_Price 97605 NEG PRES WND TX PER SESSN ProFee 976052 CDM 982 RC 97605 HCPCS facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 97605 NEG PRES WND TX PER SESSN ProFee 976052 CDM 982 RC 97605 HCPCS facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 97605 NEGATIVE PRESSURE WOUND THERAPY DME 50 SQ CM CHARGE 976061 CDM 761 RC facility both 611 611 Gross Charge Type: NIHD_Hosp_Profee_Price 97606 NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM CHARGE 976061 CDM 761 RC facility both 611 611 Gross Charge Type: NIHD_Hosp_Profee_Price 97606 Negative pressure wound therapy; total wound(s) surface area greater than 50 sq cm 976062 CDM 521 RC 97606 HCPCS facility both 102 102 Gross Charge Type: NIHD_Clinic_Price 97606 NEG PRES WND THER>50SQCM ProFee 976063 CDM 982 RC 97606 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price 97606 NEG PRES WND THER>50SQCM ProFee 976063 CDM 982 RC 97606 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price 97606 NEGATIVE PRESSURE WOUND THERAPY 50CM SQU CHARGE 976064 CDM 361 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 97606 NEGATIVE PRESSURE WOUND THERAPY 50CM SQU CHARGE 976064 CDM 361 RC facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 97607 NEG PRESSURE WOUND THERAPY NON DME 70 99100 CDM 963 RC 99100 HCPCS facility both 239 239 Gross Charge Type: NIHD_Hosp_Profee_Price 99100 ANES PRO Age <1 or >70 99100 CDM 963 RC 99100 HCPCS facility both 239 239 Gross Charge Type: NIHD_Hosp_Profee_Price 99140 Complicated by emergency situation 99140 CDM 963 RC 99140 HCPCS facility both 478 478 Gross Charge Type: NIHD_Hosp_Profee_Price 99140 Complicated by emergency situation 99140 CDM 963 RC 99140 HCPCS facility both 478 478 Gross Charge Type: NIHD_Hosp_Profee_Price 99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 991511 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 991511 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 99151 CONS SEDATE <5 YO 1ST 15M SAME PROV ProFee 991512 CDM 982 RC 99151 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 99151 CONS SEDATE <5 YO 1ST 15M SAME PROV ProFee 991512 CDM 982 RC 99151 HCPCS facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 99152 CONS SEDATE >5 YO 1ST 15M SAME PROV ProFee 99152 CDM 982 RC 99152 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 99152 CONS SEDATE >5 YO 1ST 15M SAME PROV ProFee 99152 CDM 982 RC 99152 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 99152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 991521 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 99152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 991521 CDM 450 RC facility both 999 999 Gross Charge Type: NIHD_Hosp_Profee_Price 99153 MOD SED SAME PHYS/QHP EACH ADDL 15 MINS 991531 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 99153 MOD SED SAME PHYS/QHP EACH ADDL 15 MINS 991531 CDM 450 RC facility both 501 501 Gross Charge Type: NIHD_Hosp_Profee_Price 99153 CONS SEDATE EA ADD 15MIN SAME PROVI ProFee 991533 CDM 982 RC 99153 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 99153 CONS SEDATE EA ADD 15MIN SAME PROVI ProFee 991533 CDM 982 RC 99153 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 99155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS TechFee 99155 CDM 450 RC facility both 623 623 Gross Charge Type: NIHD_Hosp_Profee_Price 99155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS TechFee 99155 CDM 450 RC facility both 623 623 Gross Charge Type: NIHD_Hosp_Profee_Price 99155 MOD SEDATION OTHER MD <5YR OLD (30 MIN) ProFee 991551 CDM 99155 HCPCS facility both 120 120 Gross Charge Type: NIHD_Hosp_Profee_Price 99155 MOD SEDATION OTHER MD <5YR OLD (30 MIN) ProFee 991551 CDM 99155 HCPCS facility both 120 120 Gross Charge Type: NIHD_Hosp_Profee_Price 99156 MOD SEDATION OTHER MD >5YR OLD (15 MIN) ProFee 99156 CDM 982 RC 99156 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 99156 MOD SEDATION OTHER MD >5YR OLD (15 MIN) ProFee 99156 CDM 982 RC 99156 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 99156 MOD SED OTH PHYS/QHP 5/>YRS TechFee 991561 CDM 450 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 99156 MOD SED OTH PHYS/QHP 5/>YRS TechFee 991561 CDM 450 RC facility both 351 351 Gross Charge Type: NIHD_Hosp_Profee_Price 99156 CONS SEDATE >5Y 1ST 15MIN DIFF PROV ProFee 991562 CDM 982 RC 99156 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 99156 CONS SEDATE >5Y 1ST 15MIN DIFF PROV ProFee 991562 CDM 982 RC 99156 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 99157 MOD SED OTHER PHYS/QHP EA TechFee 99157 CDM 450 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price 99157 MOD SED OTHER PHYS/QHP EA TechFee 99157 CDM 450 RC facility both 199 199 Gross Charge Type: NIHD_Hosp_Profee_Price 99157 MOD SEDATION OTHER MD +15 MINUTES ProFee 991571 CDM 99157 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 99157 MOD SEDATION OTHER MD +15 MINUTES ProFee 991571 CDM 99157 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 99157 CONS SEDATE EA ADD 15MIN DIFF PROVI ProFee 991572 CDM 982 RC 99157 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 99157 CONS SEDATE EA ADD 15MIN DIFF PROVI ProFee 991572 CDM 982 RC 99157 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 99173 Vision Testing POC 991731 CDM 521 RC 99173 HCPCS facility both 71 71 Gross Charge Type: NIHD_RHC_Price 99173 Vision Testing POC 991731 CDM 521 RC 99173 HCPCS facility both 71 71 Gross Charge Type: NIHD_Clinic_Price Vision Testing Clinic POC (RE) 991732 CDM 521 RC 99173 HCPCS facility both 71 71 Gross Charge Type: NIHD_RHC_Price Vision Testing Clinic POC (RE) 991732 CDM 521 RC 99173 HCPCS facility both 71 71 Gross Charge Type: NIHD_Clinic_Price "99174 Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with" 99174 CDM 521 RC 99174 HCPCS facility both 60 60 Gross Charge Type: NIHD_RHC_Price "99174 Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with" 99174 CDM 521 RC 99174 HCPCS facility both 58 58 Gross Charge Type: NIHD_Clinic_Price "99177 Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with" 99177 CDM 521 RC 99177 HCPCS facility both 92 92 Gross Charge Type: NIHD_RHC_Price "99177 Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with" 99177 CDM 521 RC 99177 HCPCS facility both 92 92 Gross Charge Type: NIHD_Clinic_Price 99184 NEONATE HYPOTHERMIA TOTAL BODY CHARGE 991841 CDM 720 RC facility both 864 864 Gross Charge Type: NIHD_Hosp_Profee_Price 99184 NEONATE HYPOTHERMIA TOTAL BODY CHARGE 991841 CDM 720 RC facility both 864 864 Gross Charge Type: NIHD_Hosp_Profee_Price 99184 HYPOTHERMIA TOTAL BODY CHARGE 991842 CDM 761 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 99184 HYPOTHERMIA TOTAL BODY CHARGE 991842 CDM 761 RC facility both 313 313 Gross Charge Type: NIHD_Hosp_Profee_Price 99188 Application of topical fluoride varnish by a physician or other qualified health care professi 99188 CDM 521 RC 99188 HCPCS facility both 66 66 Gross Charge Type: NIHD_RHC_Price 99188 Application of topical fluoride varnish by a physician or other qualified health care professi 99188 CDM 521 RC 99188 HCPCS facility both 67 67 Gross Charge Type: NIHD_Clinic_Price 99195 PHLEBOTOMY 1 UNIT - PROCEDURE Charge 99195 CDM 761 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price 99195 PHLEBOTOMY 1 UNIT - PROCEDURE Charge 99195 CDM 761 RC facility both 288 288 Gross Charge Type: NIHD_Hosp_Profee_Price "99202 Office/Outpatient Visit - New Patient, Level 2 (15-29 mins)" 992021 CDM 521 RC 99202 HCPCS facility both 211 211 Gross Charge Type: NIHD_RHC_Price "99202 Office/Outpatient Visit - New Patient, Level 2 (15-29 mins)" 992021 CDM 521 RC 99202 HCPCS facility both 250 250 Gross Charge Type: NIHD_Clinic_Price 99202 OFFICE/OP VISIT NEW-2 CHARGE Tech 992022 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 99202 OFFICE/OP VISIT NEW-2 CHARGE Tech 992022 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 99202 LEVEL 2 VISIT NEW PT ProFee 992023 CDM 982 RC 99202 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price 99202 LEVEL 2 VISIT NEW PT ProFee 992023 CDM 982 RC 99202 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price "99202 Nurse Office/Outpatient Visit - New Patient, Level 2" 992024 CDM 521 RC 99202 HCPCS facility both 211 211 Gross Charge Type: NIHD_RHC_Price "99202 Nurse Office/Outpatient Visit - New Patient, Level 2" 992024 CDM 521 RC 99202 HCPCS facility both 250 250 Gross Charge Type: NIHD_Clinic_Price 99202 NEW PATIENT LEVEL 2 992025 CDM 982 RC 99202 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price 99202 NEW PATIENT LEVEL 2 992025 CDM 982 RC 99202 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price "99203 Nurse Office/Outpatient Visit - New Patient, Level 3 (30 min)" 99203 CDM 521 RC 99203 HCPCS facility both 296 296 Gross Charge Type: NIHD_RHC_Price "99203 Nurse Office/Outpatient Visit - New Patient, Level 3 (30 min)" 99203 CDM 521 RC 99203 HCPCS facility both 332 332 Gross Charge Type: NIHD_Clinic_Price "99203 Office/Outpatient Visit - New Patient, Level 3 (30-44 min)" 992031 CDM 521 RC 99203 HCPCS facility both 296 296 Gross Charge Type: NIHD_RHC_Price "99203 Office/Outpatient Visit - New Patient, Level 3 (30-44 min)" 992031 CDM 521 RC 99203 HCPCS facility both 332 332 Gross Charge Type: NIHD_Clinic_Price 99203 OFFICE/OP VISIT NEW-3 CHARGE 992032 CDM 761 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price 99203 OFFICE/OP VISIT NEW-3 CHARGE 992032 CDM 761 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price 99203 LEVEL 3 VISIT NEW PT ProFee 992033 CDM 982 RC 99203 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 99203 LEVEL 3 VISIT NEW PT ProFee 992033 CDM 982 RC 99203 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "99204 Nurse Office/Outpatient Visit - New Patient, Level 4 (45 min)" 99204 CDM 521 RC 99204 HCPCS facility both 470 470 Gross Charge Type: NIHD_RHC_Price "99204 Nurse Office/Outpatient Visit - New Patient, Level 4 (45 min)" 99204 CDM 521 RC 99204 HCPCS facility both 438 438 Gross Charge Type: NIHD_Clinic_Price "99204 Office/Outpatient Visit - New Patient, Level 4 (45-59 min)" 992041 CDM 521 RC 99204 HCPCS facility both 470 470 Gross Charge Type: NIHD_RHC_Price "99204 Office/Outpatient Visit - New Patient, Level 4 (45-59 min)" 992041 CDM 521 RC 99204 HCPCS facility both 438 438 Gross Charge Type: NIHD_Clinic_Price 99204 OFFICE/OP VISIT NEW-4 CHARGE 992042 CDM 761 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price 99204 OFFICE/OP VISIT NEW-4 CHARGE 992042 CDM 761 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price 99204 VST NEW PAT COMPRE/MOD/COMPL ProFee 992043 CDM 982 RC 99204 HCPCS facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price 99204 VST NEW PAT COMPRE/MOD/COMPL ProFee 992043 CDM 982 RC 99204 HCPCS facility both 238 238 Gross Charge Type: NIHD_Hosp_Profee_Price "99205 Office/Outpatient Visit - New Patient, Level 5 (60 Min)" 992051 CDM 521 RC 99205 HCPCS facility both 697 697 Gross Charge Type: NIHD_RHC_Price "99205 Office/Outpatient Visit - New Patient, Level 5 (60 Min)" 992051 CDM 521 RC 99205 HCPCS facility both 535 535 Gross Charge Type: NIHD_Clinic_Price 99205 OFFICE/OP VISIT NEW-5 CHARGE Tech 992052 CDM 761 RC facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 99205 OFFICE/OP VISIT NEW-5 CHARGE Tech 992052 CDM 761 RC facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 99205 VST NEW PAT COMPRE/HIGH/COMPL ProFee 992053 CDM 982 RC 99205 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 99205 VST NEW PAT COMPRE/HIGH/COMPL ProFee 992053 CDM 982 RC 99205 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 INITIAL CLINIC VISIT/LACTATION CONSULT CHARGE 99211 CDM 761 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 INITIAL CLINIC VISIT/LACTATION CONSULT CHARGE 99211 CDM 761 RC facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price "99211 Office/Outpatient Visit - Established Patient, Level 1" 992111 CDM 521 RC 99211 HCPCS facility both 85 85 Gross Charge Type: NIHD_RHC_Price "99211 Office/Outpatient Visit - Established Patient, Level 1" 992111 CDM 521 RC 99211 HCPCS facility both 43 43 Gross Charge Type: NIHD_Clinic_Price 99211 CLINIC LEV 1 EST CHARGE 992111 CDM 761 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 CLINIC LEV 1 EST CHARGE 992111 CDM 761 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 FOLLOW UP LACTATION CONSULT CHARGE 992112 CDM 761 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 FOLLOW UP LACTATION CONSULT CHARGE 992112 CDM 761 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 OFFICE/OP VISIT EST-1 CHARGE 992113 CDM 761 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 OFFICE/OP VISIT EST-1 CHARGE 992113 CDM 761 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 LOW LEVEL CLINIC EVAL MANAGMNT Charge 992114 CDM 761 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 LOW LEVEL CLINIC EVAL MANAGMNT Charge 992114 CDM 761 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 VST EST PAT MINIMAL ProFee 992115 CDM 982 RC 99211 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 VST EST PAT MINIMAL ProFee 992115 CDM 982 RC 99211 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 LOW LEVEL NURSING VISI CHARGE 992116 CDM 761 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 99211 LOW LEVEL NURSING VISI CHARGE 992116 CDM 761 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price "99212 Office/Outpatient Visit - Established Patient, Level 2" 992121 CDM 521 RC 99212 HCPCS facility both 181 181 Gross Charge Type: NIHD_RHC_Price "99212 Office/Outpatient Visit - Established Patient, Level 2" 992121 CDM 521 RC 99212 HCPCS facility both 233 233 Gross Charge Type: NIHD_Clinic_Price 99212 Office Visit Established Pt. Level 2 (SP Pro) 992122 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 99212 Office Visit Established Pt. Level 2 (SP Pro) 992122 CDM 761 RC facility both 264 264 Gross Charge Type: NIHD_Hosp_Profee_Price 99212 LEVEL II EVAL AND MANAGEMENT Charge 992123 CDM 761 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 99212 LEVEL II EVAL AND MANAGEMENT Charge 992123 CDM 761 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 99212 VST EST PAT FOCUSED/STRGHTFWD ProFee 992124 CDM 982 RC 99212 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 99212 VST EST PAT FOCUSED/STRGHTFWD ProFee 992124 CDM 982 RC 99212 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 99212 MID LEVEL NURSING VISI CHARGE 992125 CDM 761 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price 99212 MID LEVEL NURSING VISI CHARGE 992125 CDM 761 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price "99212 Nurse Office/Outpatient Visit - Established Patient, Level 2 (10 min)" 992126 CDM 521 RC 99212 HCPCS facility both 233 233 Gross Charge Type: NIHD_RHC_Price "99212 Nurse Office/Outpatient Visit - Established Patient, Level 2 (10 min)" 992126 CDM 521 RC 99212 HCPCS facility both 233 233 Gross Charge Type: NIHD_Clinic_Price "99213 Office/Outpatient Visit - Established Patient, Level 3" 992131 CDM 521 RC 99213 HCPCS facility both 274 274 Gross Charge Type: NIHD_RHC_Price "99213 Office/Outpatient Visit - Established Patient, Level 3" 992131 CDM 521 RC 99213 HCPCS facility both 274 274 Gross Charge Type: NIHD_Clinic_Price 99213 Office Visit Established Pt. Level 3 992132 CDM 761 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price 99213 Office Visit Established Pt. Level 3 992132 CDM 761 RC facility both 370 370 Gross Charge Type: NIHD_Hosp_Profee_Price 99213 LEVEL III EVAL AND MANAGEMENT Charge 992133 CDM 761 RC facility both 282 282 Gross Charge Type: NIHD_Hosp_Profee_Price 99213 LEVEL III EVAL AND MANAGEMENT Charge 992133 CDM 761 RC facility both 282 282 Gross Charge Type: NIHD_Hosp_Profee_Price 99213 VST EST PAT EXPANDED/STRGHTFWD ProFee 992134 CDM 982 RC 99213 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price 99213 VST EST PAT EXPANDED/STRGHTFWD ProFee 992134 CDM 982 RC 99213 HCPCS facility both 139 139 Gross Charge Type: NIHD_Hosp_Profee_Price 99213 CLINIC LEV 3 EST CHARGE 992135 CDM 982 RC 99213 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price 99213 CLINIC LEV 3 EST CHARGE 992135 CDM 982 RC 99213 HCPCS facility both 102 102 Gross Charge Type: NIHD_Hosp_Profee_Price "99213 Nurse Office/Outpatient Visit - Established Patient, Level 3 (15 min)" 992136 CDM 521 RC 99213 HCPCS facility both 274 274 Gross Charge Type: NIHD_RHC_Price "99213 Nurse Office/Outpatient Visit - Established Patient, Level 3 (15 min)" 992136 CDM 521 RC 99213 HCPCS facility both 274 274 Gross Charge Type: NIHD_Clinic_Price 99213 HIGH LEVEL NURSING VISI CHARGE 992137 CDM 761 RC facility both 282 282 Gross Charge Type: NIHD_Hosp_Profee_Price 99213 HIGH LEVEL NURSING VISI CHARGE 992137 CDM 761 RC facility both 282 282 Gross Charge Type: NIHD_Hosp_Profee_Price "99214 Nurse Office/Outpatient Visit - Established Patient, Level 4 (25 min)" 99214 CDM 521 RC 99214 HCPCS facility both 355 355 Gross Charge Type: NIHD_RHC_Price "99214 Nurse Office/Outpatient Visit - Established Patient, Level 4 (25 min)" 99214 CDM 521 RC 99214 HCPCS facility both 355 355 Gross Charge Type: NIHD_Clinic_Price "99214 Office/Outpatient Visit - Established Patient, Level 4 30-39 MIN" 992141 CDM 521 RC 99214 HCPCS facility both 303 303 Gross Charge Type: NIHD_RHC_Price "99214 Office/Outpatient Visit - Established Patient, Level 4 30-39 MIN" 992141 CDM 521 RC 99214 HCPCS facility both 355 355 Gross Charge Type: NIHD_Clinic_Price 99214 OFFICE/OP VISIT EST-4 CHARGE 992142 CDM 761 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price 99214 OFFICE/OP VISIT EST-4 CHARGE 992142 CDM 761 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price 99214 VST EST PAT DET/LOW/MOD/COMPL ProFee 992143 CDM 982 RC 99214 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price 99214 VST EST PAT DET/LOW/MOD/COMPL ProFee 992143 CDM 982 RC 99214 HCPCS facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price "99215 Office/Outpatient Visit - Established Patient, Level 5 (40-54 min)." 992151 CDM 521 RC 99215 HCPCS facility both 441 441 Gross Charge Type: NIHD_RHC_Price "99215 Office/Outpatient Visit - Established Patient, Level 5 (40-54 min)." 992151 CDM 521 RC 99215 HCPCS facility both 441 441 Gross Charge Type: NIHD_Clinic_Price 99215 OFFICE/OP VISIT EST-5 CHARGE 992152 CDM 761 RC facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 99215 OFFICE/OP VISIT EST-5 CHARGE 992152 CDM 761 RC facility both 588 588 Gross Charge Type: NIHD_Hosp_Profee_Price 99215 VST EST PAT COMPRE/HIGH/COMPLX ProFee 992153 CDM 982 RC 99215 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 99215 VST EST PAT COMPRE/HIGH/COMPLX ProFee 992153 CDM 982 RC 99215 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price "99215 Nurse Office/Outpatient Visit - Established Patient, Level 5 (40 min)" 992154 CDM 521 RC 99215 HCPCS facility both 441 441 Gross Charge Type: NIHD_RHC_Price "99215 Nurse Office/Outpatient Visit - Established Patient, Level 5 (40 min)" 992154 CDM 521 RC 99215 HCPCS facility both 441 441 Gross Charge Type: NIHD_Clinic_Price "99221 Initial Hospital Care, Level 1" 992211 CDM 521 RC 99221 HCPCS facility both 365 365 Gross Charge Type: NIHD_RHC_Price 99221 LEVEL 1 ADMIT STRAIGHTFORWARD 30 MIN ProFee 992212 CDM 987 RC 99221 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 99221 LEVEL 1 ADMIT STRAIGHTFORWARD 30 MIN ProFee 992212 CDM 987 RC 99221 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 99222 LEVEL 2 ADMIT MODERATE 50 MIN ProFee 99222 CDM 987 RC 99222 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 99222 LEVEL 2 ADMIT MODERATE 50 MIN ProFee 99222 CDM 987 RC 99222 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 99223 LEVEL 3 HIGHLY COMPLEX 70 MIN ProFee 99223 CDM 987 RC 99223 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price 99223 LEVEL 3 HIGHLY COMPLEX 70 MIN ProFee 99223 CDM 987 RC 99223 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price "99231 Subsequent Hospital Care, Level 1" 992311 CDM 521 RC 99231 HCPCS facility both 156 156 Gross Charge Type: NIHD_RHC_Price "99231 Subsequent Hospital Care, Level 1" 992311 CDM 521 RC 99231 HCPCS facility both 156 156 Gross Charge Type: NIHD_Clinic_Price 99231 LEVEL 1 VISIT STABLE IMPROVING 15 MIN ProFee 992312 CDM 987 RC 99231 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price 99231 LEVEL 1 VISIT STABLE IMPROVING 15 MIN ProFee 992312 CDM 987 RC 99231 HCPCS facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price "99232 Subsequent Hospital Care, Level 2" 992321 CDM 521 RC 99232 HCPCS facility both 220 220 Gross Charge Type: NIHD_RHC_Price "99232 Subsequent Hospital Care, Level 2" 992321 CDM 521 RC 99232 HCPCS facility both 220 220 Gross Charge Type: NIHD_Clinic_Price 99232 LEVEL 2 VISIT MINOR COMPLICATION 25 MIN ProFee 992322 CDM 987 RC 99232 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 99232 LEVEL 2 VISIT MINOR COMPLICATION 25 MIN ProFee 992322 CDM 987 RC 99232 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "99233 Subsequent Hospital Care, Level 3" 992331 CDM 521 RC 99233 HCPCS facility both 300 300 Gross Charge Type: NIHD_RHC_Price "99233 Subsequent Hospital Care, Level 3" 992331 CDM 521 RC 99233 HCPCS facility both 300 300 Gross Charge Type: NIHD_Clinic_Price 99233 LEVEL 3 VISIT UNSTABLE MAJOR COMPLICATION 35 MIN ProFee 992332 CDM 987 RC 99233 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 99233 LEVEL 3 VISIT UNSTABLE MAJOR COMPLICATION 35 MIN ProFee 992332 CDM 987 RC 99233 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 99234 LEVEL 1: DETAILED HX/EXAM: STRAIGHTFORWARD SAME DAY 40 MIN ProFee 99234 CDM 987 RC 99234 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 99234 LEVEL 1: DETAILED HX/EXAM: STRAIGHTFORWARD SAME DAY 40 MIN ProFee 99234 CDM 987 RC 99234 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 99235 LEVEL 2: COMP HX/EXAM: MODERATE SAME DAY 50 MIN ProFee 99235 CDM 987 RC 99235 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price 99235 LEVEL 2: COMP HX/EXAM: MODERATE SAME DAY 50 MIN ProFee 99235 CDM 987 RC 99235 HCPCS facility both 462 462 Gross Charge Type: NIHD_Hosp_Profee_Price "99236 Hospital IP or OBS care, incl admit discharge same date" 99236 CDM 987 RC 99236 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "99236 Hospital IP or OBS care, incl admit discharge same date" 99236 CDM 987 RC 99236 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "99238 Hospital Discharge Day, <30 Minutes" 992381 CDM 521 RC 99238 HCPCS facility both 221 221 Gross Charge Type: NIHD_RHC_Price 99238 HSP DISCH DAY MGMT 30 MIN ProFee 992382 CDM 987 RC 99238 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 99238 HSP DISCH DAY MGMT 30 MIN ProFee 992382 CDM 987 RC 99238 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "99239 Hospital Discharge Day, > 30 Min" 992391 CDM 521 RC 99239 HCPCS facility both 279 279 Gross Charge Type: NIHD_RHC_Price "99239 Hospital Discharge Day, > 30 Min" 992391 CDM 521 RC 99239 HCPCS facility both 279 279 Gross Charge Type: NIHD_Clinic_Price 99239 INPT DSCHRG >30 MIN ProFee 992392 CDM 987 RC 99239 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 99239 INPT DSCHRG >30 MIN ProFee 992392 CDM 987 RC 99239 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "99242 Office Consultation, Level 2" 99242 CDM 521 RC 99242 HCPCS facility both 357 357 Gross Charge Type: NIHD_RHC_Price "99242 Office Consultation, Level 2" 99242 CDM 521 RC 99242 HCPCS facility both 357 357 Gross Charge Type: NIHD_Clinic_Price 99242 LEVEL 2 OUTPT CONSULT ProFee 992421 CDM 982 RC 99242 HCPCS facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price 99242 LEVEL 2 OUTPT CONSULT ProFee 992421 CDM 982 RC 99242 HCPCS facility both 85 85 Gross Charge Type: NIHD_Hosp_Profee_Price "99243 Office Consultation, Level 3" 99243 CDM 521 RC 99243 HCPCS facility both 365 365 Gross Charge Type: NIHD_RHC_Price "99243 Office Consultation, Level 3" 99243 CDM 521 RC 99243 HCPCS facility both 365 365 Gross Charge Type: NIHD_Clinic_Price 99243 LEVEL 3 OUTPT CONSULT ProFee 992431 CDM 982 RC 99243 HCPCS facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price 99243 LEVEL 3 OUTPT CONSULT ProFee 992431 CDM 982 RC 99243 HCPCS facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price "99244 Office Consultation, Level 4" 99244 CDM 521 RC 99244 HCPCS facility both 472 472 Gross Charge Type: NIHD_RHC_Price "99244 Office Consultation, Level 4" 99244 CDM 521 RC 99244 HCPCS facility both 472 472 Gross Charge Type: NIHD_Clinic_Price 99244 LEVEL 4 OUTPT CONSULT ProFee 992441 CDM 982 RC 99244 HCPCS facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price 99244 LEVEL 4 OUTPT CONSULT ProFee 992441 CDM 982 RC 99244 HCPCS facility both 203 203 Gross Charge Type: NIHD_Hosp_Profee_Price "99245 Office Consultation, Level 5" 99245 CDM 521 RC 99245 HCPCS facility both 575 575 Gross Charge Type: NIHD_RHC_Price "99245 Office Consultation, Level 5" 99245 CDM 521 RC 99245 HCPCS facility both 575 575 Gross Charge Type: NIHD_Clinic_Price 99245 LEVEL 5 OUTPT CONSULT ProFee 992451 CDM 982 RC 99245 HCPCS facility both 271 271 Gross Charge Type: NIHD_Hosp_Profee_Price 99245 LEVEL 5 OUTPT CONSULT ProFee 992451 CDM 982 RC 99245 HCPCS facility both 271 271 Gross Charge Type: NIHD_Hosp_Profee_Price 99252 INTL INPT CNSLT 40MINS/STFOWARD ProFee 99252 CDM 982 RC 99252 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 99252 INTL INPT CNSLT 40MINS/STFOWARD ProFee 99252 CDM 982 RC 99252 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price "99252 Inpatient Consultation, Level 2" 992521 CDM 521 RC 99252 HCPCS facility both 272 272 Gross Charge Type: NIHD_RHC_Price "99252 Inpatient Consultation, Level 2" 992521 CDM 521 RC 99252 HCPCS facility both 272 272 Gross Charge Type: NIHD_Clinic_Price 99253 INTL INPT CNSLT 55 MINS/LOW ProFee 99253 CDM 982 RC 99253 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 99253 INTL INPT CNSLT 55 MINS/LOW ProFee 99253 CDM 982 RC 99253 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 99254 INTL INPT CNSLT 80MIN/MOD ProFee 99254 CDM 982 RC 99254 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 99254 INTL INPT CNSLT 80MIN/MOD ProFee 99254 CDM 982 RC 99254 HCPCS facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 99255 INTL INPT CNSLT 110MIN/H ProFee 99255 CDM 982 RC 99255 HCPCS facility both 621 621 Gross Charge Type: NIHD_Hosp_Profee_Price 99255 INTL INPT CNSLT 110MIN/H ProFee 99255 CDM 982 RC 99255 HCPCS facility both 621 621 Gross Charge Type: NIHD_Hosp_Profee_Price "99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC" 992811 CDM 450 RC facility both 369 369 Gross Charge Type: NIHD_Hosp_Profee_Price "99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC" 992811 CDM 450 RC facility both 369 369 Gross Charge Type: NIHD_Hosp_Profee_Price 99281 Level 1 - ED Visit 992812 CDM 450 RC facility both 369 369 Gross Charge Type: NIHD_Hosp_Profee_Price 99281 Level 1 - ED Visit 992812 CDM 450 RC facility both 369 369 Gross Charge Type: NIHD_Hosp_Profee_Price 99281-E&M that may not require the presence of a physician or other qualified healthcare prof. 992813 CDM 981 RC 99281 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price 99281-E&M that may not require the presence of a physician or other qualified healthcare prof. 992813 CDM 981 RC 99281 HCPCS facility both 214 214 Gross Charge Type: NIHD_Hosp_Profee_Price "99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC" 992821 CDM 450 RC facility both 637 637 Gross Charge Type: NIHD_Hosp_Profee_Price "99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC" 992821 CDM 450 RC facility both 637 637 Gross Charge Type: NIHD_Hosp_Profee_Price 99282 Level 2 ED TechFee 992822 CDM 450 RC facility both 637 637 Gross Charge Type: NIHD_Hosp_Profee_Price 99282 Level 2 ED TechFee 992822 CDM 450 RC facility both 637 637 Gross Charge Type: NIHD_Hosp_Profee_Price 99282-E&M req. a medically appropriate hx and/or exam and straightforward medical decision making 992823 CDM 981 RC 99282 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price 99282-E&M req. a medically appropriate hx and/or exam and straightforward medical decision making 992823 CDM 981 RC 99282 HCPCS facility both 250 250 Gross Charge Type: NIHD_Hosp_Profee_Price "99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC" 992831 CDM 450 RC facility both 1091 1091 Gross Charge Type: NIHD_Hosp_Profee_Price "99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC" 992831 CDM 450 RC facility both 1091 1091 Gross Charge Type: NIHD_Hosp_Profee_Price 99283 Level 3 ED TechFee 992832 CDM 450 RC facility both 1091 1091 Gross Charge Type: NIHD_Hosp_Profee_Price 99283 Level 3 ED TechFee 992832 CDM 450 RC facility both 1091 1091 Gross Charge Type: NIHD_Hosp_Profee_Price 99283-E&M req. a medically appropriate hx and/or exam and low level medical decision making 992833 CDM 981 RC 99283 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price 99283-E&M req. a medically appropriate hx and/or exam and low level medical decision making 992833 CDM 981 RC 99283 HCPCS facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC" 992841 CDM 450 RC facility both 1737 1737 Gross Charge Type: NIHD_Hosp_Profee_Price "99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC" 992841 CDM 450 RC facility both 1737 1737 Gross Charge Type: NIHD_Hosp_Profee_Price 99284 Level 4 ED TechFee 992842 CDM 450 RC facility both 1737 1737 Gross Charge Type: NIHD_Hosp_Profee_Price 99284 Level 4 ED TechFee 992842 CDM 450 RC facility both 1737 1737 Gross Charge Type: NIHD_Hosp_Profee_Price 99284-E&M req. a medically appropriate hx and/or exam and moderate level of medical decision making 992843 CDM 981 RC 99284 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 99284-E&M req. a medically appropriate hx and/or exam and moderate level of medical decision making 992843 CDM 981 RC 99284 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price "99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC" 992851 CDM 450 RC facility both 2512 2512 Gross Charge Type: NIHD_Hosp_Profee_Price "99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC" 992851 CDM 450 RC facility both 2512 2512 Gross Charge Type: NIHD_Hosp_Profee_Price 99285 Level 5 ED TechFee 992852 CDM 450 RC facility both 2512 2512 Gross Charge Type: NIHD_Hosp_Profee_Price 99285 Level 5 ED TechFee 992852 CDM 450 RC facility both 2512 2512 Gross Charge Type: NIHD_Hosp_Profee_Price 99285-E&M req. a medically appropriate hx and/or exam and high level of medical decision making 992853 CDM 981 RC 99285 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price 99285-E&M req. a medically appropriate hx and/or exam and high level of medical decision making 992853 CDM 981 RC 99285 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price 99291 - Facility Level Critical Care Ill/Injured Patient Init 30-74 Min 99291 CDM 450 RC facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price 99291 - Facility Level Critical Care Ill/Injured Patient Init 30-74 Min 99291 CDM 450 RC facility both 2121 2121 Gross Charge Type: NIHD_Hosp_Profee_Price 99291 Level 6 ED TechFee 992911 CDM 450 RC facility both 3414 3414 Gross Charge Type: NIHD_Hosp_Profee_Price 99291 Level 6 ED TechFee 992911 CDM 450 RC facility both 3414 3414 Gross Charge Type: NIHD_Hosp_Profee_Price 99291 CRITICAL CARE E&M-UNSTABL ProFee 992912 CDM 981 RC 99291 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price 99291 CRITICAL CARE E&M-UNSTABL ProFee 992912 CDM 981 RC 99291 HCPCS facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price Critical Care Ill/Injured Patient Addl 30 Min 99292 99292 CDM 450 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price Critical Care Ill/Injured Patient Addl 30 Min 99292 99292 CDM 450 RC facility both 874 874 Gross Charge Type: NIHD_Hosp_Profee_Price 99292 Level 6 EA 30 Min TechFee 992921 CDM 450 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price 99292 Level 6 EA 30 Min TechFee 992921 CDM 450 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price 99292 CRITICAL CARE E&M-UNSTABL ProFee 992922 CDM 981 RC 99292 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 99292 CRITICAL CARE E&M-UNSTABL ProFee 992922 CDM 981 RC 99292 HCPCS facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price "99304 Initial Nursing Facility Care, Low" 993041 CDM 521 RC 99304 HCPCS facility both 161 161 Gross Charge Type: NIHD_RHC_Price "99304 Initial Nursing Facility Care, Low" 993041 CDM 521 RC 99304 HCPCS facility both 161 161 Gross Charge Type: NIHD_Clinic_Price 99304 ADMIT LOW 25 MIN ProFee 993042 CDM 987 RC 99304 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price 99304 ADMIT LOW 25 MIN ProFee 993042 CDM 987 RC 99304 HCPCS facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price "99305 Initial Nursing Facility Care, Moderate" 993051 CDM 525 RC 99305 HCPCS facility both 236 236 Gross Charge Type: NIHD_RHC_Price "99305 Initial Nursing Facility Care, Moderate" 993051 CDM 525 RC 99305 HCPCS facility both 236 236 Gross Charge Type: NIHD_Clinic_Price 99305 ADMIT MODERATE 35 MIN ProFee 993052 CDM 987 RC 99305 HCPCS facility both 236 236 Gross Charge Type: NIHD_Hosp_Profee_Price 99305 ADMIT MODERATE 35 MIN ProFee 993052 CDM 987 RC 99305 HCPCS facility both 236 236 Gross Charge Type: NIHD_Hosp_Profee_Price "99306 Initial Nursing Facility Care, High" 993061 CDM 525 RC 99306 HCPCS facility both 302 302 Gross Charge Type: NIHD_RHC_Price "99306 Initial Nursing Facility Care, High" 993061 CDM 525 RC 99306 HCPCS facility both 302 302 Gross Charge Type: NIHD_Clinic_Price "99306 INITIAL NURSING FACILITY CARE, HIGH MDM, 50+ MIN, PRO FEE" 993062 CDM 987 RC 99306 HCPCS facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price "99306 INITIAL NURSING FACILITY CARE, HIGH MDM, 50+ MIN, PRO FEE" 993062 CDM 987 RC 99306 HCPCS facility both 302 302 Gross Charge Type: NIHD_Hosp_Profee_Price "99307 Subsequent nursing facility care, per day, for evaluation" 993071 CDM 521 RC 99307 HCPCS facility both 79 79 Gross Charge Type: NIHD_RHC_Price "99307 Subsequent nursing facility care, per day, for evaluation" 993071 CDM 521 RC 99307 HCPCS facility both 79 79 Gross Charge Type: NIHD_Clinic_Price 99307 VISIT LOW 10 MIN ProFee 993072 CDM 987 RC 99307 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price 99307 VISIT LOW 10 MIN ProFee 993072 CDM 987 RC 99307 HCPCS facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price "99308 Subsequent Nursing Facility Care, Low" 993081 CDM 525 RC 99308 HCPCS facility both 126 126 Gross Charge Type: NIHD_RHC_Price "99308 Subsequent Nursing Facility Care, Low" 993081 CDM 525 RC 99308 HCPCS facility both 126 126 Gross Charge Type: NIHD_Clinic_Price 99308 VISIT MODERATE 15 MIN ProFee 993082 CDM 987 RC 99308 HCPCS facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 99308 VISIT MODERATE 15 MIN ProFee 993082 CDM 987 RC 99308 HCPCS facility both 126 126 Gross Charge Type: NIHD_Hosp_Profee_Price 99309 Nursing fac care subseq level 3 99309 CDM 525 RC 99309 HCPCS facility both 157 157 Gross Charge Type: NIHD_RHC_Price 99309 Nursing fac care subseq level 3 99309 CDM 525 RC 99309 HCPCS facility both 157 157 Gross Charge Type: NIHD_Clinic_Price "99309 Subsequent Nursing Facility Care, Moderate" 993091 CDM 525 RC 99309 HCPCS facility both 167 167 Gross Charge Type: NIHD_RHC_Price "99309 Subsequent Nursing Facility Care, Moderate" 993091 CDM 525 RC 99309 HCPCS facility both 167 167 Gross Charge Type: NIHD_Clinic_Price 99309 VISIT MOD/HIGH 25 MIN ProFee 993092 CDM 987 RC 99309 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price 99309 VISIT MOD/HIGH 25 MIN ProFee 993092 CDM 987 RC 99309 HCPCS facility both 167 167 Gross Charge Type: NIHD_Hosp_Profee_Price 99310 Nursing fac care subseq level 4 99310 CDM 525 RC 99310 HCPCS facility both 230 230 Gross Charge Type: NIHD_RHC_Price 99310 Nursing fac care subseq level 4 99310 CDM 525 RC 99310 HCPCS facility both 230 230 Gross Charge Type: NIHD_Clinic_Price "99310 Subsequent Nursing Facility Care, High" 993101 CDM 525 RC 99310 HCPCS facility both 247 247 Gross Charge Type: NIHD_RHC_Price "99310 Subsequent Nursing Facility Care, High" 993101 CDM 525 RC 99310 HCPCS facility both 247 247 Gross Charge Type: NIHD_Clinic_Price 99310 VISIT HIGH 35 MIN ProFee 993102 CDM 987 RC 99310 HCPCS facility both 247 247 Gross Charge Type: NIHD_Hosp_Profee_Price 99310 VISIT HIGH 35 MIN ProFee 993102 CDM 987 RC 99310 HCPCS facility both 247 247 Gross Charge Type: NIHD_Hosp_Profee_Price "99315 Nursing Facility Discharge, < 30 Min" 993151 CDM 525 RC 99315 HCPCS facility both 130 130 Gross Charge Type: NIHD_RHC_Price "99315 Nursing Facility Discharge, < 30 Min" 993151 CDM 525 RC 99315 HCPCS facility both 130 130 Gross Charge Type: NIHD_Clinic_Price 99315 SWINGBED DIS <30 MINS ProFee 993152 CDM 987 RC 99315 HCPCS facility both 130 130 Gross Charge Type: NIHD_Hosp_Profee_Price 99315 SWINGBED DIS <30 MINS ProFee 993152 CDM 987 RC 99315 HCPCS facility both 130 130 Gross Charge Type: NIHD_Hosp_Profee_Price "99316 Nursing Facility Discharge, 31+ Min" 993161 CDM 525 RC 99316 HCPCS facility both 185 185 Gross Charge Type: NIHD_RHC_Price "99316 Nursing Facility Discharge, 31+ Min" 993161 CDM 525 RC 99316 HCPCS facility both 185 185 Gross Charge Type: NIHD_Clinic_Price 99316 SWINGBED DIS >30 MINS ProFee 993162 CDM 987 RC 99316 HCPCS facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price 99316 SWINGBED DIS >30 MINS ProFee 993162 CDM 987 RC 99316 HCPCS facility both 185 185 Gross Charge Type: NIHD_Hosp_Profee_Price "LP SCREW, 3.0X20MM, CORTICAL, MTP, TI" 9933020 CDM 278 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "LP SCREW, 3.0X20MM, CORTICAL, MTP, TI" 9933020 CDM 278 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "LP SCREW, 3.0X18MM, CORTICAL, MTP, TI" 9933180 CDM 278 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "LP SCREW, 3.0X18MM, CORTICAL, MTP, TI" 9933180 CDM 278 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price "99341 Home Visit, New Patient, Problem Focused" 99341 CDM 521 RC 99341 HCPCS facility both 97 97 Gross Charge Type: NIHD_RHC_Price "99341 Home Visit, New Patient, Problem Focused" 99341 CDM 521 RC 99341 HCPCS facility both 97 97 Gross Charge Type: NIHD_Clinic_Price "99342 Home Visit, New Patient, Expanded Problem Focused" 99342 CDM 521 RC 99342 HCPCS facility both 137 137 Gross Charge Type: NIHD_RHC_Price "99342 Home Visit, New Patient, Expanded Problem Focused" 99342 CDM 521 RC 99342 HCPCS facility both 137 137 Gross Charge Type: NIHD_Clinic_Price "99344 Home Visit, New Patient, Comprehensive" 99344 CDM 521 RC 99344 HCPCS facility both 318 318 Gross Charge Type: NIHD_RHC_Price "99344 Home Visit, New Patient, Comprehensive" 99344 CDM 521 RC 99344 HCPCS facility both 318 318 Gross Charge Type: NIHD_Clinic_Price "99345 Home Visit, New Patient, Unstable" 99345 CDM 521 RC 99345 HCPCS facility both 389 389 Gross Charge Type: NIHD_RHC_Price "99345 Home Visit, New Patient, Unstable" 99345 CDM 521 RC 99345 HCPCS facility both 389 389 Gross Charge Type: NIHD_Clinic_Price "99347 Home Visit, Established Patient, Problem Focused" 99347 CDM 521 RC 99347 HCPCS facility both 97 97 Gross Charge Type: NIHD_RHC_Price "99347 Home Visit, Established Patient, Problem Focused" 99347 CDM 521 RC 99347 HCPCS facility both 97 97 Gross Charge Type: NIHD_Clinic_Price "99348 Home Visit, Established Patient, Expanded Problem Focused" 99348 CDM 522 RC 99348 HCPCS facility both 250 250 Gross Charge Type: NIHD_RHC_Price "99348 Home Visit, Established Patient, Expanded Problem Focused" 99348 CDM 522 RC 99348 HCPCS facility both 250 250 Gross Charge Type: NIHD_Clinic_Price "99349 Home Visit, Established Patient, Detailed" 99349 CDM 522 RC 99349 HCPCS facility both 413 413 Gross Charge Type: NIHD_RHC_Price "99349 Home Visit, Established Patient, Detailed" 99349 CDM 522 RC 99349 HCPCS facility both 413 413 Gross Charge Type: NIHD_Clinic_Price "99350 Home Visit, Established Patient, Comprehensive" 99350 CDM 521 RC 99350 HCPCS facility both 314 314 Gross Charge Type: NIHD_RHC_Price "99350 Home Visit, Established Patient, Comprehensive" 99350 CDM 521 RC 99350 HCPCS facility both 314 314 Gross Charge Type: NIHD_Clinic_Price "99358 Prolonged Services, Indirect Contact; First Hour" 99358 CDM 521 RC 99358 HCPCS facility both 167 167 Gross Charge Type: NIHD_RHC_Price "99358 Prolonged Services, Indirect Contact; First Hour" 99358 CDM 521 RC 99358 HCPCS facility both 167 167 Gross Charge Type: NIHD_Clinic_Price "99359 Prolonged Services, Indirect Contact; Addtl 30 Min" 99359 CDM 521 RC 99359 HCPCS facility both 81 81 Gross Charge Type: NIHD_RHC_Price "99359 Prolonged Services, Indirect Contact; Addtl 30 Min" 99359 CDM 521 RC 99359 HCPCS facility both 81 81 Gross Charge Type: NIHD_Clinic_Price "99381 Preventive Evaluation, New Pt; < 1 Yr" 99381 CDM 521 RC 99381 HCPCS facility both 314 314 Gross Charge Type: NIHD_RHC_Price "99381 Preventive Evaluation, New Pt; < 1 Yr" 99381 CDM 521 RC 99381 HCPCS facility both 149 149 Gross Charge Type: NIHD_Clinic_Price "99382 Preventive Evaluation, New Pt; 1-4 Yrs" 99382 CDM 521 RC 99382 HCPCS facility both 314 314 Gross Charge Type: NIHD_RHC_Price "99382 Preventive Evaluation, New Pt; 1-4 Yrs" 99382 CDM 521 RC 99382 HCPCS facility both 163 163 Gross Charge Type: NIHD_Clinic_Price "99383 Preventive Evaluation, New Pt; 5-11 Yrs" 99383 CDM 521 RC 99383 HCPCS facility both 314 314 Gross Charge Type: NIHD_RHC_Price "99383 Preventive Evaluation, New Pt; 5-11 Yrs" 99383 CDM 521 RC 99383 HCPCS facility both 227 227 Gross Charge Type: NIHD_Clinic_Price "99384 Preventive Evaluation, New Pt; 12-17 Yrs" 99384 CDM 521 RC 99384 HCPCS facility both 349 349 Gross Charge Type: NIHD_RHC_Price "99384 Preventive Evaluation, New Pt; 12-17 Yrs" 99384 CDM 521 RC 99384 HCPCS facility both 350 350 Gross Charge Type: NIHD_Clinic_Price "99385 Preventive Evaluation, New Pt; 18-39 Yrs" 99385 CDM 521 RC 99385 HCPCS facility both 418 418 Gross Charge Type: NIHD_RHC_Price "99385 Preventive Evaluation, New Pt; 18-39 Yrs" 99385 CDM 521 RC 99385 HCPCS facility both 419 419 Gross Charge Type: NIHD_Clinic_Price "99386 Preventive Evaluation, New Pt; 40-64 Yrs" 99386 CDM 521 RC 99386 HCPCS facility both 523 523 Gross Charge Type: NIHD_RHC_Price "99386 Preventive Evaluation, New Pt; 40-64 Yrs" 99386 CDM 521 RC 99386 HCPCS facility both 352 352 Gross Charge Type: NIHD_Clinic_Price "99387 Preventive Evaluation, New Pt; 65+ Yrs" 99387 CDM 521 RC 99387 HCPCS facility both 523 523 Gross Charge Type: NIHD_RHC_Price "99387 Preventive Evaluation, New Pt; 65+ Yrs" 99387 CDM 521 RC 99387 HCPCS facility both 523 523 Gross Charge Type: NIHD_Clinic_Price "99391 Preventive Evaluation, Established Pt; < 1 Yr" 99391 CDM 521 RC 99391 HCPCS facility both 211 211 Gross Charge Type: NIHD_RHC_Price "99391 Preventive Evaluation, Established Pt; < 1 Yr" 99391 CDM 521 RC 99391 HCPCS facility both 125 125 Gross Charge Type: NIHD_Clinic_Price "99392 Preventive Evaluation, Established Pt; 1-4 Yrs" 99392 CDM 521 RC 99392 HCPCS facility both 262 262 Gross Charge Type: NIHD_RHC_Price "99392 Preventive Evaluation, Established Pt; 1-4 Yrs" 99392 CDM 521 RC 99392 HCPCS facility both 139 139 Gross Charge Type: NIHD_Clinic_Price "99393 Preventive Evaluation, Established Pt; 5-11 Yrs" 99393 CDM 521 RC 99393 HCPCS facility both 314 314 Gross Charge Type: NIHD_RHC_Price "99393 Preventive Evaluation, Established Pt; 5-11 Yrs" 99393 CDM 521 RC 99393 HCPCS facility both 176 176 Gross Charge Type: NIHD_Clinic_Price "99394 Preventive Evaluation, Established Pt; 12-17 Yrs" 99394 CDM 521 RC 99394 HCPCS facility both 314 314 Gross Charge Type: NIHD_RHC_Price "99394 Preventive Evaluation, Established Pt; 12-17 Yrs" 99394 CDM 521 RC 99394 HCPCS facility both 198 198 Gross Charge Type: NIHD_Clinic_Price "99395 Preventive Evaluation, Established Pt; 18-39 Yrs" 99395 CDM 521 RC 99395 HCPCS facility both 349 349 Gross Charge Type: NIHD_RHC_Price "99395 Preventive Evaluation, Established Pt; 18-39 Yrs" 99395 CDM 521 RC 99395 HCPCS facility both 262 262 Gross Charge Type: NIHD_Clinic_Price "99396 Preventive Evaluation, Established Pt; 40-64 Yrs" 99396 CDM 521 RC 99396 HCPCS facility both 418 418 Gross Charge Type: NIHD_RHC_Price "99396 Preventive Evaluation, Established Pt; 40-64 Yrs" 99396 CDM 521 RC 99396 HCPCS facility both 324 324 Gross Charge Type: NIHD_Clinic_Price "99397 Preventive Evaluation, Established Pt; 65+ Yrs" 99397 CDM 521 RC 99397 HCPCS facility both 418 418 Gross Charge Type: NIHD_RHC_Price "99397 Preventive Evaluation, Established Pt; 65+ Yrs" 99397 CDM 521 RC 99397 HCPCS facility both 366 366 Gross Charge Type: NIHD_Clinic_Price 99401 Preventive Medicine Counseling; Approx 15 Min 99401 CDM 521 RC 99401 HCPCS facility both 68 68 Gross Charge Type: NIHD_RHC_Price 99401 Preventive Medicine Counseling; Approx 15 Min 99401 CDM 521 RC 99401 HCPCS facility both 68 68 Gross Charge Type: NIHD_Clinic_Price 99402 Preventive Medicine Counseling; Approx 30 Min 99402 CDM 521 RC 99402 HCPCS facility both 111 111 Gross Charge Type: NIHD_RHC_Price 99402 Preventive Medicine Counseling; Approx 30 Min 99402 CDM 521 RC 99402 HCPCS facility both 111 111 Gross Charge Type: NIHD_Clinic_Price 99403 Preventive Medicine Counseling; Approx 45 Min 99403 CDM 521 RC 99403 HCPCS facility both 154 154 Gross Charge Type: NIHD_RHC_Price 99403 Preventive Medicine Counseling; Approx 45 Min 99403 CDM 521 RC 99403 HCPCS facility both 154 154 Gross Charge Type: NIHD_Clinic_Price 99404 Preventive Medicine Counseling; Approx 60 Min 99404 CDM 521 RC 99404 HCPCS facility both 199 199 Gross Charge Type: NIHD_RHC_Price 99404 Preventive Medicine Counseling; Approx 60 Min 99404 CDM 521 RC 99404 HCPCS facility both 199 199 Gross Charge Type: NIHD_Clinic_Price 99406 Smoking/Tobacco Cessation Counseling; 3-10 Min 994061 CDM 521 RC 99406 HCPCS facility both 63 63 Gross Charge Type: NIHD_RHC_Price 99406 Smoking/Tobacco Cessation Counseling; 3-10 Min 994061 CDM 521 RC 99406 HCPCS facility both 63 63 Gross Charge Type: NIHD_Clinic_Price 99407 Smoking/Tobacco Cessation Counseling; 11+ Min 994071 CDM 521 RC 99407 HCPCS facility both 46 46 Gross Charge Type: NIHD_RHC_Price 99407 Smoking/Tobacco Cessation Counseling; 11+ Min 994071 CDM 521 RC 99407 HCPCS facility both 46 46 Gross Charge Type: NIHD_Clinic_Price 99408 Alcohol/Substance Abuse Structured Screen; 15-30 Min 99408 CDM 521 RC 99408 HCPCS facility both 63 63 Gross Charge Type: NIHD_RHC_Price 99408 Alcohol/Substance Abuse Structured Screen; 15-30 Min 99408 CDM 521 RC 99408 HCPCS facility both 63 63 Gross Charge Type: NIHD_Clinic_Price 99409 Alcohol/Substance Abuse Structured Screen; 30+ Min 99409 CDM 521 RC 99409 HCPCS facility both 119 119 Gross Charge Type: NIHD_RHC_Price 99409 Alcohol/Substance Abuse Structured Screen; 30+ Min 99409 CDM 521 RC 99409 HCPCS facility both 119 119 Gross Charge Type: NIHD_Clinic_Price 99411 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to indivi 99411 CDM 521 RC 99411 HCPCS facility both 34 34 Gross Charge Type: NIHD_RHC_Price 99411 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to indivi 99411 CDM 521 RC 99411 HCPCS facility both 34 34 Gross Charge Type: NIHD_Clinic_Price 99412 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to indivi 99412 CDM 521 RC 99412 HCPCS facility both 42 42 Gross Charge Type: NIHD_RHC_Price 99412 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to indivi 99412 CDM 521 RC 99412 HCPCS facility both 42 42 Gross Charge Type: NIHD_Clinic_Price 99417 PROLONG OFFICE E/M EA 15 MIN 99417 CDM 521 RC 99417 HCPCS facility both 40 40 Gross Charge Type: NIHD_RHC_Price 99417 PROLONG OFFICE E/M EA 15 MIN 99417 CDM 521 RC 99417 HCPCS facility both 40 40 Gross Charge Type: NIHD_Clinic_Price 99417 PROLONGED SERVICE 994171 CDM 982 RC 99417 HCPCS facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price 99417 PROLONGED SERVICE 994171 CDM 982 RC 99417 HCPCS facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price 99418 PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN 99418 CDM 982 RC 99418 HCPCS facility both 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price 99418 PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN 99418 CDM 982 RC 99418 HCPCS facility both 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price "99418 PROLONGED INPT/OBSV E&M W/WO DIRECT PAT CONTACT, 15 MIN OF TOTAL TIME" 994181 CDM 521 RC 99418 HCPCS facility both 119 119 Gross Charge Type: NIHD_RHC_Price "99418 PROLONGED INPT/OBSV E&M W/WO DIRECT PAT CONTACT, 15 MIN OF TOTAL TIME" 994181 CDM 521 RC 99418 HCPCS facility both 119 119 Gross Charge Type: NIHD_Clinic_Price 99421 Online Digital E&M 5-10 mins 99421 CDM 521 RC 99421 HCPCS facility both 27 27 Gross Charge Type: NIHD_RHC_Price 99421 Online Digital E&M 5-10 mins 99421 CDM 521 RC 99421 HCPCS facility both 27 27 Gross Charge Type: NIHD_Clinic_Price 99422 Online Digital E&M 11-22 mins 99422 CDM 521 RC 99422 HCPCS facility both 54 54 Gross Charge Type: NIHD_RHC_Price 99422 Online Digital E&M 11-22 mins 99422 CDM 521 RC 99422 HCPCS facility both 54 54 Gross Charge Type: NIHD_Clinic_Price 99423 Online Digital E&M 21 min or more 99423 CDM 521 RC 99423 HCPCS facility both 88 88 Gross Charge Type: NIHD_RHC_Price 99423 Online Digital E&M 21 min or more 99423 CDM 521 RC 99423 HCPCS facility both 88 88 Gross Charge Type: NIHD_Clinic_Price 99424 PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO 99424 CDM 521 RC 99424 HCPCS facility both 126 126 Gross Charge Type: NIHD_RHC_Price 99424 PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO 99424 CDM 521 RC 99424 HCPCS facility both 126 126 Gross Charge Type: NIHD_Clinic_Price 99425 PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO 99425 CDM 521 RC 99425 HCPCS facility both 91 91 Gross Charge Type: NIHD_RHC_Price 99425 PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO 99425 CDM 521 RC 99425 HCPCS facility both 91 91 Gross Charge Type: NIHD_Clinic_Price "MAXFORCE MTP PLATE, STD, 5-5, LEFT" 9944005 CDM 278 RC facility both 9975 9975 Gross Charge Type: NIHD_Hosp_Profee_Price "MAXFORCE MTP PLATE, STD, 5-5, LEFT" 9944005 CDM 278 RC facility both 9975 9975 Gross Charge Type: NIHD_Hosp_Profee_Price 99441 Telephone Evaluation and Management 5-10 mins 99441 CDM 521 RC 99441 HCPCS facility both 26 26 Gross Charge Type: NIHD_RHC_Price 99441 Telephone Evaluation and Management 5-10 mins 99441 CDM 521 RC 99441 HCPCS facility both 26 26 Gross Charge Type: NIHD_Clinic_Price 99442 Telephone Evaluation and Management 11-20 mins 99442 CDM 521 RC 99442 HCPCS facility both 49 49 Gross Charge Type: NIHD_RHC_Price 99442 Telephone Evaluation and Management 11-20 mins 99442 CDM 521 RC 99442 HCPCS facility both 49 49 Gross Charge Type: NIHD_Clinic_Price 99443 Telephone Evaluation and Management 21-30 mins 99443 CDM 521 RC 99443 HCPCS facility both 51 51 Gross Charge Type: NIHD_RHC_Price 99443 Telephone Evaluation and Management 21-30 mins 99443 CDM 521 RC 99443 HCPCS facility both 51 51 Gross Charge Type: NIHD_Clinic_Price 99446 Ntprof Phone/Ntrnet/Ehr Assmt&Mgmt 5-10 Min 99446 CDM 960 RC 99446 HCPCS facility both 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price 99446 Ntprof Phone/Ntrnet/Ehr Assmt&Mgmt 5-10 Min 99446 CDM 960 RC 99446 HCPCS facility both 27 27 Gross Charge Type: NIHD_Hosp_Profee_Price 99447 Ntprof Phone/Ntrnet/Ehr Assmt&Mgmt 11-20 Min 99447 CDM 982 RC 99447 HCPCS facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price 99447 Ntprof Phone/Ntrnet/Ehr Assmt&Mgmt 11-20 Min 99447 CDM 982 RC 99447 HCPCS facility both 53 53 Gross Charge Type: NIHD_Hosp_Profee_Price 99448 Ntprof Phone/Ntrnet/Ehr Assmt&Mgmt 21-30 Min 99448 CDM 982 RC 99448 HCPCS facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price 99448 Ntprof Phone/Ntrnet/Ehr Assmt&Mgmt 21-30 Min 99448 CDM 982 RC 99448 HCPCS facility both 81 81 Gross Charge Type: NIHD_Hosp_Profee_Price 99449 INTERPROF PHONE/ONLINE 31/> ProFee 99449 CDM 982 RC 99449 HCPCS facility both 216 216 Gross Charge Type: NIHD_Hosp_Profee_Price 99449 INTERPROF PHONE/ONLINE 31/> ProFee 99449 CDM 982 RC 99449 HCPCS facility both 216 216 Gross Charge Type: NIHD_Hosp_Profee_Price 99455 Work Related or Medical Disability Exam 99455 CDM 521 RC 99455 HCPCS facility both 178 178 Gross Charge Type: NIHD_RHC_Price 99455 Work Related or Medical Disability Exam 99455 CDM 521 RC 99455 HCPCS facility both 178 178 Gross Charge Type: NIHD_Clinic_Price 99460 INITAL NEWBORN E/M ProFee 99460 CDM 982 RC 99460 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 99460 INITAL NEWBORN E/M ProFee 99460 CDM 982 RC 99460 HCPCS facility both 301 301 Gross Charge Type: NIHD_Hosp_Profee_Price 99462 SBSQ NB EM PER DAY HOSP ProFee 99462 CDM 982 RC 99462 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price 99462 SBSQ NB EM PER DAY HOSP ProFee 99462 CDM 982 RC 99462 HCPCS facility both 151 151 Gross Charge Type: NIHD_Hosp_Profee_Price "99463 INI CARE,ADM/DS SAME DY ProFee" 99463 CDM 982 RC 99463 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price "99463 INI CARE,ADM/DS SAME DY ProFee" 99463 CDM 982 RC 99463 HCPCS facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 99464 ATTENDANCE AT DELIVERY OF NEWBORN ProFee 994641 CDM 982 RC 99464 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price 99464 ATTENDANCE AT DELIVERY OF NEWBORN ProFee 994641 CDM 982 RC 99464 HCPCS facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price RT Delivery Assist (RT) Units 994642 CDM 722 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price RT Delivery Assist (RT) Units 994642 CDM 722 RC facility both 51 51 Gross Charge Type: NIHD_Hosp_Profee_Price RT Neonatal Resuscitation CHARGE 99465 CDM 410 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price RT Neonatal Resuscitation CHARGE 99465 CDM 410 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price 99465 NEWBORN RESUSCITATION CHARGE 994651 CDM 722 RC facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 99465 NEWBORN RESUSCITATION CHARGE 994651 CDM 722 RC facility both 438 438 Gross Charge Type: NIHD_Hosp_Profee_Price 99465 NEWBORN RESUSCITATION CHARGE ProFee 994652 CDM 982 RC 99465 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 99465 NEWBORN RESUSCITATION CHARGE ProFee 994652 CDM 982 RC 99465 HCPCS facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price 99466 CRT CARE <24 MO AGE 30-74 MIN;FACE TO FA 99466 CDM 982 RC 99466 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price 99466 CRT CARE <24 MO AGE 30-74 MIN;FACE TO FA 99466 CDM 982 RC 99466 HCPCS facility both 749 749 Gross Charge Type: NIHD_Hosp_Profee_Price 99467 CRT CARE 24 MO AGE OR Yes L3766 CDM 274 RC facility both 1776 1776 Gross Charge Type: NIHD_Hosp_Profee_Price C EWHFO STATIC/DYNAMIC -> Yes L3766 CDM 274 RC facility both 1776 1776 Gross Charge Type: NIHD_Hosp_Profee_Price C WHFO DYNAMIC -> Yes L3806 CDM 274 RC facility both 595 595 Gross Charge Type: NIHD_Hosp_Profee_Price C WHFO DYNAMIC -> Yes L3806 CDM 274 RC facility both 595 595 Gross Charge Type: NIHD_Hosp_Profee_Price "L3807 Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent," L3807 CDM 521 RC L3807 HCPCS facility both 331 331 Gross Charge Type: NIHD_Clinic_Price C WHFO STATIC -> Yes L3808 CDM 274 RC facility both 595 595 Gross Charge Type: NIHD_Hosp_Profee_Price C WHFO STATIC -> Yes L3808 CDM 274 RC facility both 595 595 Gross Charge Type: NIHD_Hosp_Profee_Price C WHFO STATIC/DYNAMIC -> Yes L3900 CDM 274 RC facility both 2135 2135 Gross Charge Type: NIHD_Hosp_Profee_Price C WHFO STATIC/DYNAMIC -> Yes L3900 CDM 274 RC facility both 2135 2135 Gross Charge Type: NIHD_Hosp_Profee_Price C WHO DYNAMIC -> Yes L3905 CDM 274 RC facility both 1297 1297 Gross Charge Type: NIHD_Hosp_Profee_Price C WHO DYNAMIC -> Yes L3905 CDM 274 RC facility both 1297 1297 Gross Charge Type: NIHD_Hosp_Profee_Price C WHO STATIC -> Yes L3906 CDM 274 RC facility both 710 710 Gross Charge Type: NIHD_Hosp_Profee_Price C WHO STATIC -> Yes L3906 CDM 274 RC facility both 710 710 Gross Charge Type: NIHD_Hosp_Profee_Price "L3908 Wrist hand orthosis (WHO), wrist extension control cock-up, non molded, prefabricated, off-the" L3908 CDM 521 RC L3908 HCPCS facility both 103 103 Gross Charge Type: NIHD_RHC_Price "L3908 Wrist hand orthosis (WHO), wrist extension control cock-up, non molded, prefabricated, off-the" L3908 CDM 521 RC L3908 HCPCS facility both 103 103 Gross Charge Type: NIHD_Clinic_Price C HFO STATIC -> Yes L3913 CDM 274 RC facility both 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price C HFO STATIC -> Yes L3913 CDM 274 RC facility both 356 356 Gross Charge Type: NIHD_Hosp_Profee_Price C HO STATIC -> Yes L3919 CDM 274 RC facility both 355 355 Gross Charge Type: NIHD_Hosp_Profee_Price C HO STATIC -> Yes L3919 CDM 274 RC facility both 355 355 Gross Charge Type: NIHD_Hosp_Profee_Price C HFO DYNAMIC -> Yes L3921 CDM 274 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price C HFO DYNAMIC -> Yes L3921 CDM 274 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price L3923 Hand Finger Orthotic L3923 CDM 521 RC L3923 HCPCS facility both 119 119 Gross Charge Type: NIHD_Clinic_Price C FO STATIC -> Yes L3933 CDM 274 RC facility both 280 280 Gross Charge Type: NIHD_Hosp_Profee_Price C FO STATIC -> Yes L3933 CDM 274 RC facility both 280 280 Gross Charge Type: NIHD_Hosp_Profee_Price C FO DYNAMIC -> Yes L3935 CDM 274 RC facility both 289 289 Gross Charge Type: NIHD_Hosp_Profee_Price C FO DYNAMIC -> Yes L3935 CDM 274 RC facility both 289 289 Gross Charge Type: NIHD_Hosp_Profee_Price "L3960 Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, inc" L3960 CDM 521 RC L3960 HCPCS facility both 983 983 Gross Charge Type: NIHD_Clinic_Price Antiribosomal P Antibodies LC LCA88166 CDM 301 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price Antiribosomal P Antibodies LC LCA88166 CDM 301 RC facility both 4.89 4.89 Gross Charge Type: NIHD_Hosp_Profee_Price "Organism Identification, Yeast LC" LCA88438 CDM 306 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price "Organism Identification, Yeast LC" LCA88438 CDM 306 RC facility both 16.29 16.29 Gross Charge Type: NIHD_Hosp_Profee_Price Antifungal AST 9 Drug Panel LC LCA90104 CDM 306 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price Antifungal AST 9 Drug Panel LC LCA90104 CDM 306 RC facility both 233 233 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-COV- 2 (COVID-19) Abs LC LCA90255 CDM 300 RC facility both 42.13 42.13 Gross Charge Type: NIHD_Hosp_Profee_Price SARS-COV- 2 (COVID-19) Abs LC LCA90255 CDM 300 RC facility both 42.13 42.13 Gross Charge Type: NIHD_Hosp_Profee_Price "SARS-CoV-2 (COVID-19) Antibody, IgG LC" LCA990367 CDM 300 RC facility both 42.13 42.13 Gross Charge Type: NIHD_Hosp_Profee_Price "SARS-CoV-2 (COVID-19) Antibody, IgG LC" LCA990367 CDM 300 RC facility both 42.13 42.13 Gross Charge Type: NIHD_Hosp_Profee_Price M0220 Administration of Tixagevimab/cilgavimab injection 150mg M0220 CDM 771 RC M0220 HCPCS facility both 157 157 Gross Charge Type: NIHD_RHC_Price M0220 Administration of Tixagevimab/cilgavimab injection 150mg M0220 CDM 771 RC M0220 HCPCS facility both 157 157 Gross Charge Type: NIHD_Clinic_Price M0222 Bebtelovimab injection Administration/post admin monitoring M0222 CDM 771 RC facility both 514 514 Gross Charge Type: NIHD_Hosp_Profee_Price M0222 Bebtelovimab injection Administration/post admin monitoring M0222 CDM 771 RC facility both 514 514 Gross Charge Type: NIHD_Hosp_Profee_Price M0243 casirivimab infusion M0243 CDM 771 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price M0243 casirivimab infusion M0243 CDM 771 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price M0245 BAMLANIVIMAB AND ETESEVIMAB INFUSION M0245 CDM 771 RC facility both 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price M0245 BAMLANIVIMAB AND ETESEVIMAB INFUSION M0245 CDM 771 RC facility both 524 524 Gross Charge Type: NIHD_Hosp_Profee_Price M0247 SOTROVIMAB INFUSION M0247 CDM 771 RC facility both 786 786 Gross Charge Type: NIHD_Hosp_Profee_Price M0247 SOTROVIMAB INFUSION M0247 CDM 771 RC facility both 786 786 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL LONG 2.6 MM STRYKER MSP01160 CDM 272 RC facility both 355 355 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL LONG 2.6 MM STRYKER MSP01160 CDM 272 RC facility both 355 355 Gross Charge Type: NIHD_Hosp_Profee_Price SWIFTSET TOPICAL ADHESIVE REF#SS6 MSP10058 CDM 272 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price SWIFTSET TOPICAL ADHESIVE REF#SS6 MSP10058 CDM 272 RC facility both 75 75 Gross Charge Type: NIHD_Hosp_Profee_Price Non sufficient funds NSF CDM 999 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price Non sufficient funds NSF CDM 999 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price EpiCord EX 2x3cm OPD13781 CDM 636 RC facility both 670 670 Gross Charge Type: NIHD_Hosp_Profee_Price EpiCord EX 2x3cm OPD13781 CDM 636 RC facility both 670 670 Gross Charge Type: NIHD_Hosp_Profee_Price EpiCord 3x5cm OPD13782 CDM 636 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price EpiCord 3x5cm OPD13782 CDM 636 RC facility both 624 624 Gross Charge Type: NIHD_Hosp_Profee_Price PLEUR-X DRAINAGE CATH SYSTEM W BOTTLE OPD70114 CDM 272 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price PLEUR-X DRAINAGE CATH SYSTEM W BOTTLE OPD70114 CDM 272 RC facility both 162 162 Gross Charge Type: NIHD_Hosp_Profee_Price SURGICEL 2X3IN ABSORABLE OPD99214 CDM 272 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price SURGICEL 2X3IN ABSORABLE OPD99214 CDM 272 RC facility both 89 89 Gross Charge Type: NIHD_Hosp_Profee_Price MEDIHONEY GEL DRESSING 0.5OZ TUBE OPD99216 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price MEDIHONEY GEL DRESSING 0.5OZ TUBE OPD99216 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING JUMPSTART 2 X 5 (5CM X 12.5CM) OPD99217 CDM 272 RC facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING JUMPSTART 2 X 5 (5CM X 12.5CM) OPD99217 CDM 272 RC facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price "DRESSINGS, COLLAGEN: PURACOL PLUS COLLAG" OPD99218 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price "DRESSINGS, COLLAGEN: PURACOL PLUS COLLAG" OPD99218 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price Clear Hydro Gel Sheets 4 x 4 OPD99219 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price Clear Hydro Gel Sheets 4 x 4 OPD99219 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price Hydrofiber AG advantage 4 x 5 OPD99220 CDM 272 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price Hydrofiber AG advantage 4 x 5 OPD99220 CDM 272 RC facility both 21 21 Gross Charge Type: NIHD_Hosp_Profee_Price Hydrofiber Foam w/adhesive 5 x 5 OPD99221 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price Hydrofiber Foam w/adhesive 5 x 5 OPD99221 CDM 272 RC facility both 16 16 Gross Charge Type: NIHD_Hosp_Profee_Price Silicone Foam w/adhesive 9 x 9 OPD99222 CDM 272 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price Silicone Foam w/adhesive 9 x 9 OPD99222 CDM 272 RC facility both 25 25 Gross Charge Type: NIHD_Hosp_Profee_Price "InterDry Silver AG Textile, 10"" x 36""" OPD99225 CDM 272 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price "InterDry Silver AG Textile, 10"" x 36""" OPD99225 CDM 272 RC facility both 133 133 Gross Charge Type: NIHD_Hosp_Profee_Price "InterDry Fabric, 10""X18"", 1/Pack" OPD99226 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price "InterDry Fabric, 10""X18"", 1/Pack" OPD99226 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price AQUACEL Silcone Foam adhesive 4 x 4 OPD99227 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price AQUACEL Silcone Foam adhesive 4 x 4 OPD99227 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Silcone Foam 3 x 3 OPD99228 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Silcone Foam 3 x 3 OPD99228 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Sacram Border 6.3 x 7.9 OPD99229 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Sacram Border 6.3 x 7.9 OPD99229 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price "Hydrofera Blue Classic Antibacterial Standard Wound Dressing, 2"" x 2"" (5 cm x 5 cm)" OPD99231 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price "Hydrofera Blue Classic Antibacterial Standard Wound Dressing, 2"" x 2"" (5 cm x 5 cm)" OPD99231 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM CGF 8X8 OPD99232 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING DUODERM CGF 8X8 OPD99232 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price TISSEEL RTU FROZEN 10ML(6 MIN ORDER) ORS00260 CDM 272 RC facility both 1880 1880 Gross Charge Type: NIHD_Hosp_Profee_Price TISSEEL RTU FROZEN 10ML(6 MIN ORDER) ORS00260 CDM 272 RC facility both 1880 1880 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PERMACOL 3X8X1.00 ORS00280 CDM facility both 1977 1977 Gross Charge Type: NIHD_Hosp_Profee_Price MESH PERMACOL 3X8X1.00 ORS00280 CDM facility both 1977 1977 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 7.0 BDL ORS01030_1 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 7.0 BDL ORS01030_1 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 6.0 BDL ORS01030_2 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price IOL LI61AO 6.0 BDL ORS01030_2 CDM 276 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 10.5 BUNDLE ORS01092 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price AKREOS AO60 10.5 BUNDLE ORS01092 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 46MM ORS01215 CDM 278 RC facility both 2390 2390 Gross Charge Type: NIHD_Hosp_Profee_Price ENDO FEMORAL HEAD 46MM ORS01215 CDM 278 RC facility both 2390 2390 Gross Charge Type: NIHD_Hosp_Profee_Price VERSA-DIAL MODULAR HEAD VARIABLE OFFSET TOT SHOULDER ORS01527 CDM 278 RC facility both 3598 3598 Gross Charge Type: NIHD_Hosp_Profee_Price VERSA-DIAL MODULAR HEAD VARIABLE OFFSET TOT SHOULDER ORS01527 CDM 278 RC facility both 3598 3598 Gross Charge Type: NIHD_Hosp_Profee_Price PREVENA INCISION MANAGEMENT SYSTEM 20 CM ORS01704 CDM 271 RC facility both 1159 1159 Gross Charge Type: NIHD_Hosp_Profee_Price PREVENA INCISION MANAGEMENT SYSTEM 20 CM ORS01704 CDM 271 RC facility both 1159 1159 Gross Charge Type: NIHD_Hosp_Profee_Price PREVENA CANISTER ORS01705 CDM 271 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price PREVENA CANISTER ORS01705 CDM 271 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 4 LEFT ORS01721 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 4 LEFT ORS01721 CDM 278 RC facility both 15003 15003 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASE PLATE UNIVERSAL SZ 4 ORS01722 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BASE PLATE UNIVERSAL SZ 4 ORS01722 CDM 278 RC facility both 13199 13199 Gross Charge Type: NIHD_Hosp_Profee_Price SYMMETRIC PATELLA SZ S29MMX8MM ORS01723 CDM 278 RC facility both 5176 5176 Gross Charge Type: NIHD_Hosp_Profee_Price SYMMETRIC PATELLA SZ S29MMX8MM ORS01723 CDM 278 RC facility both 5176 5176 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DILATION FILIFORM COUDE TIP 4FR ORS01724_272 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DILATION FILIFORM COUDE TIP 4FR ORS01724_272 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4X11 MM ORS01724_278 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4X11 MM ORS01724_278 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 2-0 ON GS-21 90 9 IN LONG ORS01728 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE VLOC 2-0 ON GS-21 90 9 IN LONG ORS01728 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price CAPSULAR TENSION RING 13mm ORS10149 CDM facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price CAPSULAR TENSION RING 13mm ORS10149 CDM facility both 825 825 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERWIRE #2 AR-7200 ORS10205 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERWIRE #2 AR-7200 ORS10205 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 X 25MM LOW PROFILE HEX ORS10220 CDM 278 RC facility both 570 570 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 X 25MM LOW PROFILE HEX ORS10220 CDM 278 RC facility both 570 570 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32MM CODE G ORS10260_1 CDM 278 RC facility both 7817 7817 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32MM CODE G ORS10260_1 CDM 278 RC facility both 7817 7817 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 10 DEGREE 36F ORS10260_2 CDM 278 RC facility both 8795 8795 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 10 DEGREE 36F ORS10260_2 CDM 278 RC facility both 8795 8795 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE ACETABULAR SZ 48MM D ORS10261 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE ACETABULAR SZ 48MM D ORS10261 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 36 X -5MM ORS10262_1 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 36 X -5MM ORS10262_1 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM +7.5MM ORS10262_2 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE SZ 56MM F ORS10262_2 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SHELL CLUSTER HOLE SZ 56MM F ORS10262_3 CDM 278 RC facility both 11484 11484 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAGITTAL MICRO KM-3101 ORS10283 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE SAGITTAL MICRO KM-3101 ORS10283 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-106 ORS10290 CDM 273 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SAW BLADE MICRO KM3-106 ORS10290 CDM 273 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE 14 STANDARD* ORS1222 CDM 270 RC facility both 16971 16971 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE-14 STANDARD ORS1222 CDM 278 RC facility both 14662 14662 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL STEM ADVOCATE-14 STANDARD ORS1222_278 CDM 278 RC facility both 14662 14662 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 12CM ORS12382 CDM 272 RC facility both 1332 1332 Gross Charge Type: NIHD_Hosp_Profee_Price MESH SYMBOTEX COMP MESH 12CM ORS12382 CDM 272 RC facility both 1332 1332 Gross Charge Type: NIHD_Hosp_Profee_Price TRUNODE HANDPIECES S-10 ORS12423 CDM 272 RC facility both 898 898 Gross Charge Type: NIHD_Hosp_Profee_Price TRUNODE HANDPIECES S-10 ORS12423 CDM 272 RC facility both 898 898 Gross Charge Type: NIHD_Hosp_Profee_Price 7972-08 NORMAL SALINE 3000C ORS12463 CDM 250 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price 7972-08 NORMAL SALINE 3000C ORS12463 CDM 250 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLES SCORPION MULTIFIRE ORS12527 CDM 272 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLES SCORPION MULTIFIRE ORS12527 CDM 272 RC facility both 510 510 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX35MM ORS12620 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price T2 F/T LOCKING SCREW 5MMX35MM ORS12620 CDM 278 RC facility both 442 442 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X75MM TI CANNULATED SCREW 602675 ORS12664 CDM 278 RC facility both 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X75MM TI CANNULATED SCREW 602675 ORS12664 CDM 278 RC facility both 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X85MM TI CANNULATED SCREW 602685 ORS12665 CDM 278 RC facility both 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X85MM TI CANNULATED SCREW 602685 ORS12665 CDM 278 RC facility both 697 697 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.25X150MM SS ORS12681 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE 1.25X150MM SS ORS12681 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE RETRACTABLE L-HOOK ORS12686 CDM 272 RC facility both 1848 1848 Gross Charge Type: NIHD_Hosp_Profee_Price LIGASURE RETRACTABLE L-HOOK ORS12686 CDM 272 RC facility both 1848 1848 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X11MM BONE SCREWSCROSSPINSELFTAPPING ORS12698 CDM 278 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price 2.3X11MM BONE SCREWSCROSSPINSELFTAPPING ORS12698 CDM 278 RC facility both 192 192 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X110MM TI CANNULATED SCREW 602710 ORS12707_272 CDM 272 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X110MM TI CANNULATED SCREW 602710 ORS12707_272 CDM 272 RC facility both 1080 1080 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 5 35X108MM ORS12707_278 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE ACC 11 SIZE# 5 35X108MM ORS12707_278 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE 127 DEG ACC 11 7X37X114M ORS127071 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price STEM HIP ANGLE 127 DEG ACC 11 7X37X114M ORS127071 CDM 278 RC facility both 24008 24008 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 272 UM HOLM RD TIP SMA905 ORS12724 CDM 272 RC facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price LASER FIBER 272 UM HOLM RD TIP SMA905 ORS12724 CDM 272 RC facility both 494 494 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 12X83MM LONG ORS12823 CDM 278 RC facility both 21228 21228 Gross Charge Type: NIHD_Hosp_Profee_Price SHOULDER STEM 12X83MM LONG ORS12823 CDM 278 RC facility both 21228 21228 Gross Charge Type: NIHD_Hosp_Profee_Price CENTRALIZER DISTAL VERSYS 14MM ORS1300 CDM 278 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price CENTRALIZER DISTAL VERSYS 14MM ORS1300 CDM 278 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price TOGGLELOC WITH ZIPLOOP 2.9MM ORS13128 CDM 278 RC facility both 2369 2369 Gross Charge Type: NIHD_Hosp_Profee_Price TOGGLELOC WITH ZIPLOOP 2.9MM ORS13128 CDM 278 RC facility both 2369 2369 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX RIGHT ORS13182 CDM facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX RIGHT ORS13182 CDM facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX LEFT ORS13183 CDM facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX LEFT ORS13183 CDM facility both 1078 1078 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX LEFT LARGE LITE ORS13189 CDM 278 RC facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX LEFT LARGE LITE ORS13189 CDM 278 RC facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX RIGHT LARGE LITE ORS13190 CDM 278 RC facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX RIGHT LARGE LITE ORS13190 CDM 278 RC facility both 1398 1398 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHREX KNOT PUSHER /SUTURE CUTTER ORS13195 CDM facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHREX KNOT PUSHER /SUTURE CUTTER ORS13195 CDM facility both 750 750 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 3-0 P-12 (PS-2) ORS13233 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 3-0 P-12 (PS-2) ORS13233 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 2-0 V-20 UNDYED ORS13252 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 2-0 V-20 UNDYED ORS13252 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ALLOGRAFT GRAFTLINK CP SYSTEM ORS13499 CDM 272 RC facility both 3001 3001 Gross Charge Type: NIHD_Hosp_Profee_Price ALLOGRAFT GRAFTLINK CP SYSTEM ORS13499 CDM 272 RC facility both 3001 3001 Gross Charge Type: NIHD_Hosp_Profee_Price VENTRALIGHT ST MESH 6 INCH CIRC ORS13521 CDM 278 RC facility both 4465 4465 Gross Charge Type: NIHD_Hosp_Profee_Price VENTRALIGHT ST MESH 6 INCH CIRC ORS13521 CDM 278 RC facility both 4465 4465 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X11MM LOCKING SCREWS,CROSS-PIN,SELF-T" ORS13533 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X11MM LOCKING SCREWS,CROSS-PIN,SELF-T" ORS13533 CDM 278 RC facility both 336 336 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X12MM LOCKING SCREWS,CROSS-PIN,SELF-T" ORS13534 CDM 278 RC facility both 230 230 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3X12MM LOCKING SCREWS,CROSS-PIN,SELF-T" ORS13534 CDM 278 RC facility both 230 230 Gross Charge Type: NIHD_Hosp_Profee_Price GEMINI SR8 SELF RETAINING CANNULA ORS13601 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price GEMINI SR8 SELF RETAINING CANNULA ORS13601 CDM 272 RC facility both 96 96 Gross Charge Type: NIHD_Hosp_Profee_Price MERIDIAN VPS DEVICE SYSTEM UROLOGY ORS13605 CDM 272 RC facility both 1164 1164 Gross Charge Type: NIHD_Hosp_Profee_Price MERIDIAN VPS DEVICE SYSTEM UROLOGY ORS13605 CDM 272 RC facility both 1164 1164 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORRIGHTTIBIA2HOLE/L95MM ORS13623 CDM 278 RC facility both 5572 5572 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORRIGHTTIBIA2HOLE/L95MM ORS13623 CDM 278 RC facility both 5572 5572 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM -2.5M ORS13655 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL C-TAP CERAMIC SZ 36MM -2.5M ORS13655 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO-PROFILE NON-LOCK 3.5X20 ORS13665 CDM 278 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO-PROFILE NON-LOCK 3.5X20 ORS13665 CDM 278 RC facility both 105 105 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX LEFT LITE XTRA LARGE ORS13666 CDM facility both 1188 1188 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX LEFT LITE XTRA LARGE ORS13666 CDM facility both 1188 1188 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX RIGHT LITE XTRA LARGE ORS13667 CDM 278 RC facility both 1541 1541 Gross Charge Type: NIHD_Hosp_Profee_Price MESH 3-D MAX RIGHT LITE XTRA LARGE ORS13667 CDM 278 RC facility both 1541 1541 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO LOCK SCRW SS 2.7X16MM ORS13691 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO LOCK SCRW SS 2.7X16MM ORS13691 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0MM GRADUATED ORS13739 CDM 272 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.0MM GRADUATED ORS13739 CDM 272 RC facility both 286 286 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5MM ORS13740 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5MM ORS13740 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT GRADUATED 2.5MM ORS13741 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT GRADUATED 2.5MM ORS13741 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO LOCK SCRW SS 2.7X14MM ORS13744 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO LOCK SCRW SS 2.7X14MM ORS13744 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price FLOSEAL HEMOSTATIC MATRIX 10ML(NEED TIPS ORS13763 CDM 272 RC facility both 1233 1233 Gross Charge Type: NIHD_Hosp_Profee_Price FLOSEAL HEMOSTATIC MATRIX 10ML(NEED TIPS ORS13763 CDM 272 RC facility both 1233 1233 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORRIGHTTIBIA5HOLE/L84MM ORS13765 CDM 278 RC facility both 5072 5072 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAPLATEFORRIGHTTIBIA5HOLE/L84MM ORS13765 CDM 278 RC facility both 5072 5072 Gross Charge Type: NIHD_Hosp_Profee_Price SPEEDBRG IMP SYS W/BIO-COMP SWVLK ORS13772 CDM 278 RC facility both 5218 5218 Gross Charge Type: NIHD_Hosp_Profee_Price SPEEDBRG IMP SYS W/BIO-COMP SWVLK ORS13772 CDM 278 RC facility both 5218 5218 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO LOCK SCRW SS 2.7X18MM ORS13788 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price LO-PRO LOCK SCRW SS 2.7X18MM ORS13788 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price SLING ALTIS KIT UROLOGY ORS13819 CDM facility both 4400 4400 Gross Charge Type: NIHD_Hosp_Profee_Price SLING ALTIS KIT UROLOGY ORS13819 CDM facility both 4400 4400 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 X 30MM LOW PROFILE HEX ORS13843 CDM 278 RC facility both 570 570 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 6.5 X 30MM LOW PROFILE HEX ORS13843 CDM 278 RC facility both 570 570 Gross Charge Type: NIHD_Hosp_Profee_Price Val Near Cortex TiT Locking Screw 2.4 x 24 ORS13874 CDM 278 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price Val Near Cortex TiT Locking Screw 2.4 x 24 ORS13874 CDM 278 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING TITANIUM 3.5MM X16MM ORS13877 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOCKING TITANIUM 3.5MM X16MM ORS13877 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRES TROCAR TIP 1.35MM ORS13880 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price GUIDEWIRES TROCAR TIP 1.35MM ORS13880 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3 M PROFYLE HAND LOCK PLATE,STRAI,4H" ORS13895 CDM 278 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3 M PROFYLE HAND LOCK PLATE,STRAI,4H" ORS13895 CDM 278 RC facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3 M PROFYLE HANDLOCK T-PLATE,NAR,6H" ORS13902 CDM facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3 M PROFYLE HANDLOCK T-PLATE,NAR,6H" ORS13902 CDM facility both 1044 1044 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3 M PROFYLE HANDLOCK T-PLATE,REG,7H" ORS13903 CDM 278 RC facility both 1410 1410 Gross Charge Type: NIHD_Hosp_Profee_Price "2.3 M PROFYLE HANDLOCK T-PLATE,REG,7H" ORS13903 CDM 278 RC facility both 1410 1410 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIGRAFT QUADLINK(10X69) ORS13923 CDM 278 RC facility both 7795 7795 Gross Charge Type: NIHD_Hosp_Profee_Price FLEXIGRAFT QUADLINK(10X69) ORS13923 CDM 278 RC facility both 7795 7795 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS FIBERTAK 1.8MM STRAIGHT ORS13934 CDM facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS FIBERTAK 1.8MM STRAIGHT ORS13934 CDM facility both 526 526 Gross Charge Type: NIHD_Hosp_Profee_Price "T-ROPE KNOTLESS,SYN REPAIR SS KIT" ORS13946 CDM 278 RC facility both 4483 4483 Gross Charge Type: NIHD_Hosp_Profee_Price "T-ROPE KNOTLESS,SYN REPAIR SS KIT" ORS13946 CDM 278 RC facility both 4483 4483 Gross Charge Type: NIHD_Hosp_Profee_Price GLENOID MODULAR POST SIZE4 ORS13954 CDM 278 RC facility both 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price GLENOID MODULAR POST SIZE4 ORS13954 CDM 278 RC facility both 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price HEADLESS TROCAR DRILL PIN 3.2 X 75MM ORS13955 CDM 272 RC facility both 877 877 Gross Charge Type: NIHD_Hosp_Profee_Price HEADLESS TROCAR DRILL PIN 3.2 X 75MM ORS13955 CDM 272 RC facility both 877 877 Gross Charge Type: NIHD_Hosp_Profee_Price GLENOID BASE SIZE 4 ORS13956 CDM 278 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price GLENOID BASE SIZE 4 ORS13956 CDM 278 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price BROAD BAND SUTURE TAPE (SHOULDERS) ORS13957 CDM 271 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price BROAD BAND SUTURE TAPE (SHOULDERS) ORS13957 CDM 271 RC facility both 109 109 Gross Charge Type: NIHD_Hosp_Profee_Price Volar Distal Radius Plate Standard Left 3 hole ORS13982 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price Volar Distal Radius Plate Standard Left 3 hole ORS13982 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 MM LOW PROFILE SCREW NONLOCKING TIT CORTICAL ORS13984 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 MM LOW PROFILE SCREW NONLOCKING TIT CORTICAL ORS13984 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 3.5 LOW PRO FIXED CORT LOCK 14MM ORS13986 CDM 278 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 3.5 LOW PRO FIXED CORT LOCK 14MM ORS13986 CDM 278 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 2.4 VAL NEAR CORTEX LOCK 22MM ORS13990 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 2.4 VAL NEAR CORTEX LOCK 22MM ORS13990 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price GLENOID MODULAR PEG 4 SZ3 ORS13998 CDM 278 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price GLENOID MODULAR PEG 4 SZ3 ORS13998 CDM 278 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO QUICK-PASS 90 DEG STRAIGHT ORS14019 CDM 272 RC facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO QUICK-PASS 90 DEG STRAIGHT ORS14019 CDM 272 RC facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO QUICK-PASS 90 DEG CURVE RT ORS14020 CDM facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO QUICK-PASS 90 DEG CURVE RT ORS14020 CDM facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO QUICK-PASS 45 DEG CURVE RT ORS14021 CDM 272 RC facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO QUICK-PASS 45 DEG CURVE RT ORS14021 CDM 272 RC facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO QICK-PASS 90 DEG CURVE LT ORS14022 CDM 272 RC facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE LASSO QICK-PASS 90 DEG CURVE LT ORS14022 CDM 272 RC facility both 480 480 Gross Charge Type: NIHD_Hosp_Profee_Price MESH RESTORELLE Y UROLOGY ORS14023 CDM 278 RC facility both 2759 2759 Gross Charge Type: NIHD_Hosp_Profee_Price MESH RESTORELLE Y UROLOGY ORS14023 CDM 278 RC facility both 2759 2759 Gross Charge Type: NIHD_Hosp_Profee_Price XI DA VINCI ENDOWRIST SUCTION IRRIGATOR ORS14024 CDM 272 RC facility both 796 796 Gross Charge Type: NIHD_Hosp_Profee_Price XI DA VINCI ENDOWRIST SUCTION IRRIGATOR ORS14024 CDM 272 RC facility both 796 796 Gross Charge Type: NIHD_Hosp_Profee_Price ACL REPAIR IMPLANT SYSTEM ORS14025 CDM 278 RC facility both 6433 6433 Gross Charge Type: NIHD_Hosp_Profee_Price ACL REPAIR IMPLANT SYSTEM ORS14025 CDM 278 RC facility both 6433 6433 Gross Charge Type: NIHD_Hosp_Profee_Price "SECONDARY FIXATION KIT, 4.75 X 19.1 SWIVELOCK" ORS14026 CDM 278 RC facility both 1800 1800 Gross Charge Type: NIHD_Hosp_Profee_Price "SECONDARY FIXATION KIT, 4.75 X 19.1 SWIVELOCK" ORS14026 CDM 278 RC facility both 1800 1800 Gross Charge Type: NIHD_Hosp_Profee_Price BROADBAND LOOP ORS14027 CDM facility both 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price BROADBAND LOOP ORS14027 CDM facility both 235 235 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERSTITCH CURVED WITH 2-0 FIBERWIRE ORS14028 CDM 278 RC facility both 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERSTITCH CURVED WITH 2-0 FIBERWIRE ORS14028 CDM 278 RC facility both 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price STEMMED FEMORAL COMPONENT ORS14030 CDM 278 RC facility both 8321 8321 Gross Charge Type: NIHD_Hosp_Profee_Price STEMMED FEMORAL COMPONENT ORS14030 CDM 278 RC facility both 8321 8321 Gross Charge Type: NIHD_Hosp_Profee_Price STEM EXTENSION COMPONENT ORS14031 CDM 278 RC facility both 5398 5398 Gross Charge Type: NIHD_Hosp_Profee_Price STEM EXTENSION COMPONENT ORS14031 CDM 278 RC facility both 5398 5398 Gross Charge Type: NIHD_Hosp_Profee_Price STEMMED TIBIAL COMPONENT ORS14032 CDM 278 RC facility both 16731 16731 Gross Charge Type: NIHD_Hosp_Profee_Price STEMMED TIBIAL COMPONENT ORS14032 CDM 278 RC facility both 16731 16731 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT MIXING VACUUM SYSTEM ZIMMER ORS14035 CDM 272 RC facility both 296 296 Gross Charge Type: NIHD_Hosp_Profee_Price CEMENT MIXING VACUUM SYSTEM ZIMMER ORS14035 CDM 272 RC facility both 296 296 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 4 ORS14036 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 4 ORS14036 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL COLUMN SMARTLOCK PLATE SHORT ORS14037 CDM 278 RC facility both 1742 1742 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL COLUMN SMARTLOCK PLATE SHORT ORS14037 CDM 278 RC facility both 1742 1742 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL COLUMN SMARTLOCK PLATE LONG ORS14038 CDM 278 RC facility both 1742 1742 Gross Charge Type: NIHD_Hosp_Profee_Price RADIAL COLUMN SMARTLOCK PLATE LONG ORS14038 CDM 278 RC facility both 1742 1742 Gross Charge Type: NIHD_Hosp_Profee_Price ULNAR COLUMN SMARTLOCK PLATE SHORT RIGHT ORS14039 CDM 278 RC facility both 1742 1742 Gross Charge Type: NIHD_Hosp_Profee_Price ULNAR COLUMN SMARTLOCK PLATE SHORT RIGHT ORS14039 CDM 278 RC facility both 1742 1742 Gross Charge Type: NIHD_Hosp_Profee_Price ULNAR COLUMN SMARTLOCK PLATE SHORT LEFT ORS14040 CDM 278 RC facility both 1742 1742 Gross Charge Type: NIHD_Hosp_Profee_Price ULNAR COLUMN SMARTLOCK PLATE SHORT LEFT ORS14040 CDM 278 RC facility both 1742 1742 Gross Charge Type: NIHD_Hosp_Profee_Price ULNAR COLUMN SMARTLOCK PLATE LONG RIGHT ORS14041 CDM 278 RC facility both 2544 2544 Gross Charge Type: NIHD_Hosp_Profee_Price ULNAR COLUMN SMARTLOCK PLATE LONG RIGHT ORS14041 CDM 278 RC facility both 2544 2544 Gross Charge Type: NIHD_Hosp_Profee_Price ULNAR COLUMN SMARTLOCK PLATE LONG LEFT ORS14042 CDM 278 RC facility both 2544 2544 Gross Charge Type: NIHD_Hosp_Profee_Price ULNAR COLUMN SMARTLOCK PLATE LONG LEFT ORS14042 CDM 278 RC facility both 2544 2544 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X30MM ORS14043 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X30MM ORS14043 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X32MM ORS14044 CDM 278 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X32MM ORS14044 CDM 278 RC facility both 181 181 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X34MM ORS14045 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X34MM ORS14045 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X36MM ORS14046 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X36MM ORS14046 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X38MM ORS14047 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T7 2.3X38MM ORS14047 CDM 278 RC facility both 343 343 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X10MM ORS14048 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X10MM ORS14048 CDM 278 RC facility both 242 242 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X12MM ORS14049 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X12MM ORS14049 CDM 278 RC facility both 457 457 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X14MM ORS14050 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.3X14MM ORS14050 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X16 ORS14051 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X16 ORS14051 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X18 ORS14052 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X18 ORS14052 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X20 ORS14053 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X20 ORS14053 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X22 ORS14054 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X22 ORS14054 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X24 ORS14055 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X24 ORS14055 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X26 ORS14056 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED BONE SCREW T7 2.7X26 ORS14056 CDM 278 RC facility both 444 444 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X26MM ORS14057 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREWS T7 2.7X26MM ORS14057 CDM 278 RC facility both 458 458 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X16 ORS14058 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X16 ORS14058 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X18 ORS14059 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X18 ORS14059 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X20 ORS14060 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X20 ORS14060 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X22 ORS14061 CDM facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X22 ORS14061 CDM facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X24 ORS14062 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X24 ORS14062 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X26 ORS14063 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price PARTIALLY THREADED LOCKING PEG T7 2.7X26 ORS14063 CDM 278 RC facility both 460 460 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK PLATE STANDARD RIGHT ORS14064 CDM 278 RC facility both 3482 3482 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK PLATE STANDARD RIGHT ORS14064 CDM 278 RC facility both 3482 3482 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK PLATE STANDARD LEFT ORS14065 CDM 278 RC facility both 3482 3482 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK PLATE STANDARD LEFT ORS14065 CDM 278 RC facility both 3482 3482 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK PLATE WIDE RIGHT ORS14066 CDM 278 RC facility both 3482 3482 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK PLATE WIDE RIGHT ORS14066 CDM 278 RC facility both 3482 3482 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK PLATE WIDE LEFT ORS14067 CDM 278 RC facility both 3482 3482 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK PLATE WIDE LEFT ORS14067 CDM 278 RC facility both 3482 3482 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK DR PLATE STAND R X LONG ORS14068 CDM 278 RC facility both 4018 4018 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK DR PLATE STAND R X LONG ORS14068 CDM 278 RC facility both 4018 4018 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK DR PLATE WIDE R X LONG ORS14069 CDM 278 RC facility both 4018 4018 Gross Charge Type: NIHD_Hosp_Profee_Price DORSAL SMARTLOCK DR PLATE WIDE R X LONG ORS14069 CDM 278 RC facility both 4018 4018 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 3-0 180 GREEN V-20 TAPER ORS14070 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 3-0 180 GREEN V-20 TAPER ORS14070 CDM 272 RC facility both 83 83 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 0 ON GS-21 18IN LONG ORS14071 CDM 272 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 0 ON GS-21 18IN LONG ORS14071 CDM 272 RC facility both 106 106 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 0 ON GS-22 18IN LONG PBT ORS14072 CDM 272 RC facility both 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE V-LOC 0 ON GS-22 18IN LONG PBT ORS14072 CDM 272 RC facility both 104 104 Gross Charge Type: NIHD_Hosp_Profee_Price HD Scorpion Needle ORS14073 CDM 272 RC facility both 148 148 Gross Charge Type: NIHD_Hosp_Profee_Price HD Scorpion Needle ORS14073 CDM 272 RC facility both 148 148 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLES SCORPION HIP ARTHROSCOPIES ORS14074 CDM 272 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price NEEDLES SCORPION HIP ARTHROSCOPIES ORS14074 CDM 272 RC facility both 118 118 Gross Charge Type: NIHD_Hosp_Profee_Price BEARING STANDARD 36MM ORS14075 CDM 278 RC facility both 2999 2999 Gross Charge Type: NIHD_Hosp_Profee_Price BEARING STANDARD 36MM ORS14075 CDM 278 RC facility both 2999 2999 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE SHOULDER SYSTEM 40MM ORS14076 CDM 278 RC facility both 5697 5697 Gross Charge Type: NIHD_Hosp_Profee_Price REVERSE SHOULDER SYSTEM 40MM ORS14076 CDM 278 RC facility both 5697 5697 Gross Charge Type: NIHD_Hosp_Profee_Price LOW-PROFILE AC REPAIR SYSTEM ORS14077 CDM 278 RC facility both 5131 5131 Gross Charge Type: NIHD_Hosp_Profee_Price LOW-PROFILE AC REPAIR SYSTEM ORS14077 CDM 278 RC facility both 5131 5131 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLT TI STD RT 3H ORS14078 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLT TI STD RT 3H ORS14078 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT VAL 2.4 LOCKING SIZE 18 ORS14082 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT VAL 2.4 LOCKING SIZE 18 ORS14082 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 2.4 VAL NEAR CORTEX LOCK 20MM ORS14083 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 2.4 VAL NEAR CORTEX LOCK 20MM ORS14083 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 3.5 LOW PRO CORT LOCK 14MM ORS14087 CDM 278 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 3.5 LOW PRO CORT LOCK 14MM ORS14087 CDM 278 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO-PRO TI 3.5MMX16MM ORS14088 CDM 278 RC facility both 259 259 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO-PRO TI 3.5MMX16MM ORS14088 CDM 278 RC facility both 259 259 Gross Charge Type: NIHD_Hosp_Profee_Price Suture Stratafix 3-0 Undyed ORS14089 CDM 272 RC facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price Suture Stratafix 3-0 Undyed ORS14089 CDM 272 RC facility both 68 68 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 6 X12MM ORS14090 CDM 278 RC facility both 26101 26101 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 6 X12MM ORS14090 CDM 278 RC facility both 26101 26101 Gross Charge Type: NIHD_Hosp_Profee_Price 5 x 100 Kii FIOS bladeless trocar ORS14091 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price 5 x 100 Kii FIOS bladeless trocar ORS14091 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price 5 x 100 Kii Bladed trocar Zthread ORS14092 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price 5 x 100 Kii Bladed trocar Zthread ORS14092 CDM 272 RC facility both 180 180 Gross Charge Type: NIHD_Hosp_Profee_Price 12 x 100 Kii Bladed trocar Zthread ORS14093 CDM 272 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price 12 x 100 Kii Bladed trocar Zthread ORS14093 CDM 272 RC facility both 211 211 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 2.4MM LOW PROFILE NON LOCKING LASER MARKED HEAD 26 MM ORS14095 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 2.4MM LOW PROFILE NON LOCKING LASER MARKED HEAD 26 MM ORS14095 CDM 278 RC facility both 773 773 Gross Charge Type: NIHD_Hosp_Profee_Price XI SMALL GRASPER RETRACTOR ORS14098 CDM 272 RC facility both 7196 7196 Gross Charge Type: NIHD_Hosp_Profee_Price XI SMALL GRASPER RETRACTOR ORS14098 CDM 272 RC facility both 7196 7196 Gross Charge Type: NIHD_Hosp_Profee_Price Alcon PikPak ORS14099 CDM 250 RC facility both 144 144 Gross Charge Type: NIHD_Hosp_Profee_Price Alcon PikPak ORS14099 CDM 250 RC facility both 144 144 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 2-0 GS-22 UNDYED ORS15000 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 2-0 GS-22 UNDYED ORS15000 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 0 GS-22 ORS15001 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE POLYSORB 0 GS-22 ORS15001 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5MM LASER MARKED ORS15002 CDM 272 RC facility both 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 2.5MM LASER MARKED ORS15002 CDM 272 RC facility both 204 204 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW LEFT 3 HOLE ORS15003 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW LEFT 3 HOLE ORS15003 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW LEFT 5 HOLE ORS15004 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW LEFT 5 HOLE ORS15004 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW LEFT 7 HOLE ORS15005 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW LEFT 7 HOLE ORS15005 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW LEFT 9 HOLE ORS15006 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW LEFT 9 HOLE ORS15006 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW RIGHT 3 HOLE ORS15007 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW RIGHT 3 HOLE ORS15007 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW RIGHT 5 HOLE ORS15008 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW RIGHT 5 HOLE ORS15008 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW RIGHT 7 HOLE ORS15009 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW RIGHT 7 HOLE ORS15009 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW RIGHT 9 HOLE ORS15010 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price VOLAR DISTAL RAD PLATE NARROW RIGHT 9 HOLE ORS15010 CDM 278 RC facility both 2385 2385 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4MM X 22 LOW PROFILE TIT CORTEX NONLOCKING ORS15011 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4MM X 22 LOW PROFILE TIT CORTEX NONLOCKING ORS15011 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.4X24MM ARTHREX ORS15012 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CORT 2.4X24MM ARTHREX ORS15012 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4MM X 26 LOW PROFILE TIT CORTEX NONLOCKING ORS15013 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4MM X 26 LOW PROFILE TIT CORTEX NONLOCKING ORS15013 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4MM X 28 LOW PROFILE TIT CORTEX ORS15014 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4MM X 28 LOW PROFILE TIT CORTEX ORS15014 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4MM X 30 LOW PROFILE TIT CORTEX NONLOCKING ORS15015 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4MM X 30 LOW PROFILE TIT CORTEX NONLOCKING ORS15015 CDM 278 RC facility both 330 330 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X12 LOW PROFILE TIT LOCKING SCREW ORS15019 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X12 LOW PROFILE TIT LOCKING SCREW ORS15019 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 20 LOW PROFILE TIT LOCKING SCREW ORS15020 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 20 LOW PROFILE TIT LOCKING SCREW ORS15020 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 2.4 VAL NEAR CORTEX LOCK 24MM ORS15021 CDM 278 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW TIT 2.4 VAL NEAR CORTEX LOCK 24MM ORS15021 CDM 278 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 14 LOW PROFILE TIT LOCKING SCREW ORS15022 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 14 LOW PROFILE TIT LOCKING SCREW ORS15022 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 16 LOW PROFILE TIT LOCKING SCREW ORS15023 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 16 LOW PROFILE TIT LOCKING SCREW ORS15023 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 18 LOW PROFILE TIT LOCKING SCREW ORS15025 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5MM X 18 LOW PROFILE TIT LOCKING SCREW ORS15025 CDM 278 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 12.0 ORS15026 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 12.0 ORS15026 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 25.0 ORS15029 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 25.0 ORS15029 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 23 +0 V40 ORS15031 CDM 278 RC facility both 23414 23414 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 23 +0 V40 ORS15031 CDM 278 RC facility both 23414 23414 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 195X20 ORS15032 CDM 278 RC facility both 17082 17082 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 195X20 ORS15032 CDM 278 RC facility both 17082 17082 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL DISTAL AUGMENT RIGHT SZ 4X5MM ORS15033 CDM 278 RC facility both 5892 5892 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL DISTAL AUGMENT RIGHT SZ 4X5MM ORS15033 CDM 278 RC facility both 5892 5892 Gross Charge Type: NIHD_Hosp_Profee_Price STEM CEMENTED 15X100MM ORS15034 CDM 278 RC facility both 13155 13155 Gross Charge Type: NIHD_Hosp_Profee_Price STEM CEMENTED 15X100MM ORS15034 CDM 278 RC facility both 13155 13155 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL INSERT TOTAL STABILIZER SZ 4X11M ORS15035 CDM 278 RC facility both 12530 12530 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL INSERT TOTAL STABILIZER SZ 4X11M ORS15035 CDM 278 RC facility both 12530 12530 Gross Charge Type: NIHD_Hosp_Profee_Price STEM CEMENTED 12X100MM ORS15036 CDM 278 RC facility both 6264 6264 Gross Charge Type: NIHD_Hosp_Profee_Price STEM CEMENTED 12X100MM ORS15036 CDM 278 RC facility both 6264 6264 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMP STABLIZER SZ 4 RIGHT ORS15037 CDM 278 RC facility both 3428 3428 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL COMP STABLIZER SZ 4 RIGHT ORS15037 CDM 278 RC facility both 3428 3428 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR AUGMENT SZ 4X5MM ORS15038ORS15038 CDM 278 RC facility both 6189 6189 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR AUGMENT SZ 4X5MM ORS15038ORS15038 CDM 278 RC facility both 6189 6189 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL SYMMETRIC CONE AUGMENT SZ C ORS15039 CDM 278 RC facility both 21863 21863 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL SYMMETRIC CONE AUGMENT SZ C ORS15039 CDM 278 RC facility both 21863 21863 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 2.7 CORTICAL LOW PROFILE ORS15040 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 2.7 CORTICAL LOW PROFILE ORS15040 CDM 278 RC facility both 372 372 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO PROFILE NON-LOCK CORT 3.5X20MM ORS15041 CDM 278 RC facility both 1208 1208 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LO PROFILE NON-LOCK CORT 3.5X20MM ORS15041 CDM 278 RC facility both 1208 1208 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW-PRO-FILE LOCKING 2.7 X 20MM ORS15042 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW LOW-PRO-FILE LOCKING 2.7 X 20MM ORS15042 CDM 278 RC facility both 346 346 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 23.0 ORS15043 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 23.0 ORS15043 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 23.5 ORS15044 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 23.5 ORS15044 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 24.0 ORS15045 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 24.0 ORS15045 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 24.5 ORS15046 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 24.5 ORS15046 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 25.5 ORS15048 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 25.5 ORS15048 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 26.0 ORS15050 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 26.0 ORS15050 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 27.0 ORS15051 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 27.0 ORS15051 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 27.5 ORS15052 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 27.5 ORS15052 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 28.0 ORS15053 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 28.0 ORS15053 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 28.5 ORS15054 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 28.5 ORS15054 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 29.0 ORS15055 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 29.0 ORS15055 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 29.5 ORS15056 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 29.5 ORS15056 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 30.0 ORS15057 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 30.0 ORS15057 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 12.5 ORS15059 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 12.5 ORS15059 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 13.0 ORS15060 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 13.0 ORS15060 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 13.5 ORS15061 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 13.5 ORS15061 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 14.0 ORS15062 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 14.0 ORS15062 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 14.5 ORS15063 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 14.5 ORS15063 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 15.0 ORS15064 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 15.0 ORS15064 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 15.5 ORS15065 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 15.5 ORS15065 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 16.0 ORS15066 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 16.0 ORS15066 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 16.5 ORS15067 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 16.5 ORS15067 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 17.0 ORS15068 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 17.0 ORS15068 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 17.5 ORS15069 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 17.5 ORS15069 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 18.0 ORS15070 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 18.0 ORS15070 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 18.5 ORS15071 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 18.5 ORS15071 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 19.0 ORS15072 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 19.0 ORS15072 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 19.5 ORS15073 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 19.5 ORS15073 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 20.0 ORS15074 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 20.0 ORS15074 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 20.5 ORS15075 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 20.5 ORS15075 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 21.0 ORS15076 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 21.0 ORS15076 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 21.5 ORS15077 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 21.5 ORS15077 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 22.0 ORS15078 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 22.0 ORS15078 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 22.5 ORS15079 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 22.5 ORS15079 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price PMMA Single Piece IOL Lens 20.0 ORS15080 CDM 276 RC facility both 213 213 Gross Charge Type: NIHD_Hosp_Profee_Price PMMA Single Piece IOL Lens 20.0 ORS15080 CDM 276 RC facility both 213 213 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 19.5 TFNT3019.5 ORS15081 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 19.5 TFNT3019.5 ORS15081 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 10.5 TFNT0010.5 ORS15082 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 10.5 TFNT0010.5 ORS15082 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36F ORS15083 CDM 278 RC facility both 8539 8539 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 36F ORS15083 CDM 278 RC facility both 8539 8539 Gross Charge Type: NIHD_Hosp_Profee_Price Screw Lo-Pro Cannulated Short Thread 4x38 ORS15084 CDM 278 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price Screw Lo-Pro Cannulated Short Thread 4x38 ORS15084 CDM 278 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price Screw Lo-Pro Cannulated Short Thread 4x40 ORS15085 CDM 278 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price Screw Lo-Pro Cannulated Short Thread 4x40 ORS15085 CDM 278 RC facility both 495 495 Gross Charge Type: NIHD_Hosp_Profee_Price "Electrode-Coated Flat L-Hook, 36 cm" ORS15086 CDM 272 RC facility both 123 123 Gross Charge Type: NIHD_Hosp_Profee_Price "Electrode-Coated Flat L-Hook, 36 cm" ORS15086 CDM 272 RC facility both 123 123 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTER BOVIE UROLOGY GENERATOR ORS15087 CDM 272 RC facility both 568 568 Gross Charge Type: NIHD_Hosp_Profee_Price ADAPTER BOVIE UROLOGY GENERATOR ORS15087 CDM 272 RC facility both 568 568 Gross Charge Type: NIHD_Hosp_Profee_Price "Endo Catch II Retriever, 15 mm" ORS15088 CDM 272 RC facility both 383 383 Gross Charge Type: NIHD_Hosp_Profee_Price "Endo Catch II Retriever, 15 mm" ORS15088 CDM 272 RC facility both 383 383 Gross Charge Type: NIHD_Hosp_Profee_Price "Endoscopic Dissector, 5 mm" ORS15089 CDM 272 RC facility both 708 708 Gross Charge Type: NIHD_Hosp_Profee_Price "Endoscopic Dissector, 5 mm" ORS15089 CDM 272 RC facility both 708 708 Gross Charge Type: NIHD_Hosp_Profee_Price "Endoscopic Roticulator Dissecting Instrument, 5 mm" ORS15090 CDM 272 RC facility both 404 404 Gross Charge Type: NIHD_Hosp_Profee_Price "Endoscopic Roticulator Dissecting Instrument, 5 mm" ORS15090 CDM 272 RC facility both 404 404 Gross Charge Type: NIHD_Hosp_Profee_Price Epix Universal Clip Applier (5mm) ORS15091 CDM 272 RC facility both 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price Epix Universal Clip Applier (5mm) ORS15091 CDM 272 RC facility both 360 360 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSHEARS 5MM DISPOSABLE ORS15092 CDM 272 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price ENDOSHEARS 5MM DISPOSABLE ORS15092 CDM 272 RC facility both 706 706 Gross Charge Type: NIHD_Hosp_Profee_Price PlasmaLoop Medium ESG 12 ORS15093 CDM 272 RC facility both 8966 8966 Gross Charge Type: NIHD_Hosp_Profee_Price PlasmaLoop Medium ESG 12 ORS15093 CDM 272 RC facility both 8966 8966 Gross Charge Type: NIHD_Hosp_Profee_Price PlasmaLoop Large ESG 12 ORS15094 CDM 272 RC facility both 8966 8966 Gross Charge Type: NIHD_Hosp_Profee_Price PlasmaLoop Large ESG 12 ORS15094 CDM 272 RC facility both 8966 8966 Gross Charge Type: NIHD_Hosp_Profee_Price GLIDEWIRE 0.035 STRTIP STIFF BODY 3 CM ORS15095 CDM 272 RC facility both 652 652 Gross Charge Type: NIHD_Hosp_Profee_Price GLIDEWIRE 0.035 STRTIP STIFF BODY 3 CM ORS15095 CDM 272 RC facility both 652 652 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE GUIDE AMPLATZ 0.035 ORS15096 CDM 272 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price WIRE GUIDE AMPLATZ 0.035 ORS15096 CDM 272 RC facility both 70 70 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7mm Non-Locking Screws 24mm ORS16003 CDM 278 RC facility both 248 248 Gross Charge Type: NIHD_Hosp_Profee_Price 2.7mm Non-Locking Screws 24mm ORS16003 CDM 278 RC facility both 248 248 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L30mm" ORS16005 CDM 278 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price "Locking Screw,T8 Full Thread, 2.7mm/L30mm" ORS16005 CDM 278 RC facility both 425 425 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4mm Narrow Locking Plate Straight 8 Hole ORS16008 CDM 278 RC facility both 1843 1843 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4mm Narrow Locking Plate Straight 8 Hole ORS16008 CDM 278 RC facility both 1843 1843 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4mm Narrow Locking T-Plate 2x5 Hole ORS16009 CDM 278 RC facility both 1843 1843 Gross Charge Type: NIHD_Hosp_Profee_Price 2.4mm Narrow Locking T-Plate 2x5 Hole ORS16009 CDM 278 RC facility both 1843 1843 Gross Charge Type: NIHD_Hosp_Profee_Price Sensor wire PTFE Guidewire with Hydrophilic Angled tip ORS16013_1 CDM 272 RC facility both 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price Sensor wire PTFE Guidewire with Hydrophilic Angled tip ORS16013_1 CDM 272 RC facility both 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price Sensor wire Nitinol hydrophilic straight tip ORS16013_2 CDM 272 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price Sensor wire Nitinol hydrophilic straight tip ORS16013_2 CDM 272 RC facility both 176 176 Gross Charge Type: NIHD_Hosp_Profee_Price Sensor wire PTFE Guidewire with Hydrophilic straight tip ORS16014 CDM 272 RC facility both 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price Sensor wire PTFE Guidewire with Hydrophilic straight tip ORS16014 CDM 272 RC facility both 168 168 Gross Charge Type: NIHD_Hosp_Profee_Price Versa-Dial Humeral head 4x27x46 ORS16015 CDM 278 RC facility both 3598 3598 Gross Charge Type: NIHD_Hosp_Profee_Price Versa-Dial Humeral head 4x27x46 ORS16015 CDM 278 RC facility both 3598 3598 Gross Charge Type: NIHD_Hosp_Profee_Price Glenoid Drill Bit ORS16016 CDM 272 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price Glenoid Drill Bit ORS16016 CDM 272 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price Stryker Sagittal Saw Blade ORS16017_1 CDM 272 RC facility both 153 153 Gross Charge Type: NIHD_Hosp_Profee_Price Stryker Sagittal Saw Blade ORS16017_1 CDM 272 RC facility both 153 153 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRT TIP 6FR 12.5 ORS16017_2 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price CATHETER DIL FILIFORM STRT TIP 6FR 12.5 ORS16017_2 CDM 272 RC facility both 217 217 Gross Charge Type: NIHD_Hosp_Profee_Price Long Medium Aggressive blade 31.0 x 90 mm ORS16018 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price Long Medium Aggressive blade 31.0 x 90 mm ORS16018 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price Precision thin long med blade 9.0 x 0.38 x 31.0 ORS16019 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price Precision thin long med blade 9.0 x 0.38 x 31.0 ORS16019 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price Self-drilling Hybrid Half-Pin 4/5x 150mm ORS16020 CDM 272 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price Self-drilling Hybrid Half-Pin 4/5x 150mm ORS16020 CDM 272 RC facility both 352 352 Gross Charge Type: NIHD_Hosp_Profee_Price Cystoscope Flexible Neoflex ORS16021 CDM 278 RC C1747 HCPCS facility both 1679 1679 Gross Charge Type: NIHD_Clinic_Price Cystoscope Flexible Neoflex ORS16021 CDM 278 RC facility both 1679 1679 Gross Charge Type: NIHD_Hosp_Profee_Price Cystoscope Flexible Neoflex ORS16021 CDM 278 RC facility both 1679 1679 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 11.0 ORS16022 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 11.0 ORS16022 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price Surgicel Endoscopic Applicator ORS16023 CDM 272 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price Surgicel Endoscopic Applicator ORS16023 CDM 272 RC facility both 57 57 Gross Charge Type: NIHD_Hosp_Profee_Price "Surgicel Powder Absorbable Hemostat, 3g" ORS16024 CDM 272 RC facility both 470 470 Gross Charge Type: NIHD_Hosp_Profee_Price "Surgicel Powder Absorbable Hemostat, 3g" ORS16024 CDM 272 RC facility both 470 470 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 6.5 ORS16025 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 6.5 ORS16025 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 19.0 TFNT0019.0 ORS16026 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 19.0 TFNT0019.0 ORS16026 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 18.0 ORS16027 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 18.0 ORS16027 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 24.0 TFNT0024.0 ORS16028 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 24.0 TFNT0024.0 ORS16028 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE BIOSYN 3-0 V-20 ORS16029 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE BIOSYN 3-0 V-20 ORS16029 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price BREG KNEE BRACE T-SCOPE REGULAR ORS16030 CDM 274 RC L1833 HCPCS facility both 198 198 Gross Charge Type: NIHD_RHC_Price BREG KNEE BRACE T-SCOPE REGULAR ORS16030 CDM 274 RC L1833 HCPCS facility both 198 198 Gross Charge Type: NIHD_Clinic_Price BREG KNEE BRACE T-SCOPE REGULAR ORS16030 CDM 274 RC facility both 198 198 Gross Charge Type: NIHD_Hosp_Profee_Price BREG KNEE BRACE T-SCOPE REGULAR ORS16030 CDM 274 RC facility both 198 198 Gross Charge Type: NIHD_Hosp_Profee_Price BREG KNEE BRACE T SCOPE LARGE 17-27IN ORS16031 CDM 274 RC facility both 198 198 Gross Charge Type: NIHD_Hosp_Profee_Price BREG KNEE BRACE T SCOPE LARGE 17-27IN ORS16031 CDM 274 RC facility both 198 198 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE NYLON 10-0 (EYE) ORS16032 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE NYLON 10-0 (EYE) ORS16032 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price "SUTURE POLYSORB 2-0 GS-21 30"" UND" ORS16033 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price "SUTURE POLYSORB 2-0 GS-21 30"" UND" ORS16033 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price Piranha biopsy Forcep ORS16034 CDM 272 RC facility both 1238 1238 Gross Charge Type: NIHD_Hosp_Profee_Price Piranha biopsy Forcep ORS16034 CDM 272 RC facility both 1238 1238 Gross Charge Type: NIHD_Hosp_Profee_Price SYMMETRIC PATELLA S29MMX8MM ORS16035 CDM 278 RC facility both 5176 5176 Gross Charge Type: NIHD_Hosp_Profee_Price SYMMETRIC PATELLA S29MMX8MM ORS16035 CDM 278 RC facility both 5176 5176 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3 X10MM ORS16036 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3 X10MM ORS16036 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32G ORS16037_1 CDM 278 RC facility both 7817 7817 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEGREE 32G ORS16037_1 CDM 278 RC facility both 7817 7817 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 32X +4MM ORS16037_2 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price HEAD FEMORAL LFIT V40 32X +4MM ORS16037_2 CDM 278 RC facility both 8345 8345 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 8.0 OPTIC LENS ORS16040 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 8.0 OPTIC LENS ORS16040 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 10.0 TFNT6010.0 ORS16041 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 10.0 TFNT6010.0 ORS16041 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 9.5 OPTIC LENS ORS16042 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 9.5 OPTIC LENS ORS16042 CDM 276 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT6 17.5 ORS16043 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT6 17.5 ORS16043 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3 X14MM ORS16045 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 3 X14MM ORS16045 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 8.5 ORS16046 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 8.5 ORS16046 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price Modular Head Variable Offset 42head 21height 43curve ORS16047 CDM 278 RC facility both 3598 3598 Gross Charge Type: NIHD_Hosp_Profee_Price Modular Head Variable Offset 42head 21height 43curve ORS16047 CDM 278 RC facility both 3598 3598 Gross Charge Type: NIHD_Hosp_Profee_Price Alliance Glenoid Modular 4 Peg Size 2 ORS16048 CDM 278 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price Alliance Glenoid Modular 4 Peg Size 2 ORS16048 CDM 278 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price Standard Taper Adapter ORS16049 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price Standard Taper Adapter ORS16049 CDM 278 RC facility both 600 600 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 13.0 TFNT5013.0 ORS16050 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 13.0 TFNT5013.0 ORS16050 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Laser Fiber HOL270SBX ORS16051 CDM 272 RC facility both 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price Laser Fiber HOL270SBX ORS16051 CDM 272 RC facility both 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price Laser Fiber HOL400SBX ORS16052 CDM 272 RC facility both 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price Laser Fiber HOL400SBX ORS16052 CDM 272 RC facility both 492 492 Gross Charge Type: NIHD_Hosp_Profee_Price PMMA Single Piece IOL Lens 18.5 ORS16053 CDM 276 RC facility both 244 244 Gross Charge Type: NIHD_Hosp_Profee_Price PMMA Single Piece IOL Lens 18.5 ORS16053 CDM 276 RC facility both 244 244 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 23.5 OPTIC LENS ORS16054 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 23.5 OPTIC LENS ORS16054 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 13.0 OPTIC LENS ORS16056_1 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 13.0 OPTIC LENS ORS16056_1 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 13.5 TFNT0013.5 ORS16056_2 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 13.5 TFNT0013.5 ORS16056_2 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 24.5 TFNT245 ORS16057 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 24.5 TFNT245 ORS16057 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 8.5 ORS16058 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 8.5 ORS16058 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 18.5 TFNT0018.5 ORS16059 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 18.5 TFNT0018.5 ORS16059 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 24.5 TFNT3024.5 ORS16060 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 24.5 TFNT3024.5 ORS16060 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 23.5 ORS16061 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 23.5 ORS16061 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 12.0 ORS16062 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 12.0 ORS16062 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price Trabecular metal Glenoid Modular Post ORS70090 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price Trabecular metal Glenoid Modular Post ORS70090 CDM 278 RC facility both 1050 1050 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SIZE 6 LEFT PS ORS70091 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SIZE 6 LEFT PS ORS70091 CDM 278 RC facility both 15157 15157 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 6 9MM ORS70092 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 6 9MM ORS70092 CDM 278 RC facility both 10440 10440 Gross Charge Type: NIHD_Hosp_Profee_Price Suture Lasso 25 deg right ORS70093 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price Suture Lasso 25 deg right ORS70093 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price Suture Lasso 25 Deg Left ORS70094 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price Suture Lasso 25 Deg Left ORS70094 CDM 272 RC facility both 420 420 Gross Charge Type: NIHD_Hosp_Profee_Price Blunt Tip Cann Lag Crew 42mm-04mm ORS70096 CDM 278 RC facility both 605 605 Gross Charge Type: NIHD_Hosp_Profee_Price Blunt Tip Cann Lag Crew 42mm-04mm ORS70096 CDM 278 RC facility both 605 605 Gross Charge Type: NIHD_Hosp_Profee_Price BONUS TRIAD 1CC ORS70097 CDM 278 RC facility both 1895 1895 Gross Charge Type: NIHD_Hosp_Profee_Price BONUS TRIAD 1CC ORS70097 CDM 278 RC facility both 1895 1895 Gross Charge Type: NIHD_Hosp_Profee_Price BONUS TRIAD 5CC ORS70098 CDM 278 RC facility both 7102 7102 Gross Charge Type: NIHD_Hosp_Profee_Price BONUS TRIAD 5CC ORS70098 CDM 278 RC facility both 7102 7102 Gross Charge Type: NIHD_Hosp_Profee_Price BROAD STRAIGHT PLATE SHORT ORS70099 CDM 278 RC facility both 1571 1571 Gross Charge Type: NIHD_Hosp_Profee_Price BROAD STRAIGHT PLATE SHORT ORS70099 CDM 278 RC facility both 1571 1571 Gross Charge Type: NIHD_Hosp_Profee_Price BROAD STRAIGHT PLATE MEDIUM ORS70100 CDM 278 RC facility both 1641 1641 Gross Charge Type: NIHD_Hosp_Profee_Price BROAD STRAIGHT PLATE MEDIUM ORS70100 CDM 278 RC facility both 1641 1641 Gross Charge Type: NIHD_Hosp_Profee_Price Anterolateral Ligament Reconstruction Implant System ORS70101 CDM 278 RC facility both 3299 3299 Gross Charge Type: NIHD_Hosp_Profee_Price Anterolateral Ligament Reconstruction Implant System ORS70101 CDM 278 RC facility both 3299 3299 Gross Charge Type: NIHD_Hosp_Profee_Price FlexiGRAFT Semi-Tendinosus Tendon-ZORC ORS70102 CDM 278 RC facility both 4111 4111 Gross Charge Type: NIHD_Hosp_Profee_Price FlexiGRAFT Semi-Tendinosus Tendon-ZORC ORS70102 CDM 278 RC facility both 4111 4111 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DIST HUM 3 HL RT S 2.7 X 3.5 ORS70103 CDM 278 RC facility both 4037 4037 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE DIST HUM 3 HL RT S 2.7 X 3.5 ORS70103 CDM 278 RC facility both 4037 4037 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE MED DIST HUM 1 HL RT S 2.7 X 3.5 ORS70104 CDM 278 RC facility both 4037 4037 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE MED DIST HUM 1 HL RT S 2.7 X 3.5 ORS70104 CDM 278 RC facility both 4037 4037 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 2.7X14 METAPH STARDRIVE ORS70105 CDM 278 RC facility both 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 2.7X14 METAPH STARDRIVE ORS70105 CDM 278 RC facility both 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 2.7X24 METAPH STARDRIVE ORS70106 CDM 278 RC facility both 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW 2.7X24 METAPH STARDRIVE ORS70106 CDM 278 RC facility both 163 163 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X10 T8 SD ORS70107 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X10 T8 SD ORS70107 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X16 T8 SD ORS70108 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X16 T8 SD ORS70108 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X18 T8 SD ORS70109 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X18 T8 SD ORS70109 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X20 T8 SD ORS70110 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X20 T8 SD ORS70110 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X24 T8 SD ORS70111 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW VA LOCK 2.7X24 T8 SD ORS70111 CDM 278 RC facility both 507 507 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 1.6MM TROCAR SINGLE PT ORS70112 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price K-WIRE SYNTHES 1.6MM TROCAR SINGLE PT ORS70112 CDM 278 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT W DEPTH MARK 2.0X140MM QC ORS70113 CDM 272 RC facility both 544 544 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT W DEPTH MARK 2.0X140MM QC ORS70113 CDM 272 RC facility both 544 544 Gross Charge Type: NIHD_Hosp_Profee_Price Leg Positioner Disposables Kit ORS70115 CDM 272 RC facility both 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price Leg Positioner Disposables Kit ORS70115 CDM 272 RC facility both 175 175 Gross Charge Type: NIHD_Hosp_Profee_Price "Mako, Sagittal Blade, Narrow" ORS70116 CDM 272 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price "Mako, Sagittal Blade, Narrow" ORS70116 CDM 272 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price "Mako, Sagittal Blade, Standard" ORS70117 CDM 272 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price "Mako, Sagittal Blade, Standard" ORS70117 CDM 272 RC facility both 523 523 Gross Charge Type: NIHD_Hosp_Profee_Price Vizadisc Knee Tracking Kit ORS70118 CDM 272 RC facility both 1096 1096 Gross Charge Type: NIHD_Hosp_Profee_Price Vizadisc Knee Tracking Kit ORS70118 CDM 272 RC facility both 1096 1096 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Pin, 3.2 x 140mm (2 pack)" ORS70119 CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Pin, 3.2 x 140mm (2 pack)" ORS70119 CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Pin, 3.2 x 110mm (2 pack)" ORS70120 CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Pin, 3.2 x 110mm (2 pack)" ORS70120 CDM 278 RC facility both 325 325 Gross Charge Type: NIHD_Hosp_Profee_Price Femoral/Tibial Checkpoint Kit ORS70121 CDM 272 RC facility both 484 484 Gross Charge Type: NIHD_Hosp_Profee_Price Femoral/Tibial Checkpoint Kit ORS70121 CDM 272 RC facility both 484 484 Gross Charge Type: NIHD_Hosp_Profee_Price Silicone Retractor Cord ORS70122 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price Silicone Retractor Cord ORS70122 CDM 272 RC facility both 37 37 Gross Charge Type: NIHD_Hosp_Profee_Price "Undyed Ethicon Monocryl Monofilament Absorbable Prime Reverse Cutting 3/8C 4-0 PS-2 18"" Suture" ORS70123 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "Undyed Ethicon Monocryl Monofilament Absorbable Prime Reverse Cutting 3/8C 4-0 PS-2 18"" Suture" ORS70123 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "MONOCRYL Plus Suture, PS-2, Undyed, Size 3-0, 18" ORS70124 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "MONOCRYL Plus Suture, PS-2, Undyed, Size 3-0, 18" ORS70124 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "Stratafix Spiral PDO Suture, 3/8 Circle, Reverse, 2-0, 24 mm x 24 mm" ORS70125 CDM 272 RC facility both 117 117 Gross Charge Type: NIHD_Hosp_Profee_Price "Stratafix Spiral PDO Suture, 3/8 Circle, Reverse, 2-0, 24 mm x 24 mm" ORS70125 CDM 272 RC facility both 117 117 Gross Charge Type: NIHD_Hosp_Profee_Price "Undyed Ethicon Monocryl Monofilament Absorbable Prime Reverse Cutting 3/8C 3-0 PS-2 18"" Suture" ORS70126 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "Undyed Ethicon Monocryl Monofilament Absorbable Prime Reverse Cutting 3/8C 3-0 PS-2 18"" Suture" ORS70126 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "MONOCRYL Plus Suture, PS-2, Undyed, Size 4-0, 18" ORS70127 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price "MONOCRYL Plus Suture, PS-2, Undyed, Size 4-0, 18" ORS70127 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHREX QUADLINK 10 MM KIT ORS70128 CDM 272 RC facility both 6522 6522 Gross Charge Type: NIHD_Hosp_Profee_Price ARTHREX QUADLINK 10 MM KIT ORS70128 CDM 272 RC facility both 6522 6522 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz4 RT CR ORS70129 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz4 RT CR ORS70129 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Asymmetric Patella sz A29mm 9mm ORS70130 CDM 278 RC facility both 5691 5691 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Asymmetric Patella sz A29mm 9mm ORS70130 CDM 278 RC facility both 5691 5691 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 3 ORS70131 CDM 278 RC facility both 15259 15259 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 3 ORS70131 CDM 278 RC facility both 15259 15259 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz3 RT CR ORS70132 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz3 RT CR ORS70132 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Asymmetric Patella SZ A9 9mm ORS70133 CDM 278 RC facility both 5332 5332 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Asymmetric Patella SZ A9 9mm ORS70133 CDM 278 RC facility both 5332 5332 Gross Charge Type: NIHD_Hosp_Profee_Price CHIBA NEEDLE 22 GA X 20 CM ORS70134 CDM 272 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price CHIBA NEEDLE 22 GA X 20 CM ORS70134 CDM 272 RC facility both 48 48 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 4 ORS70135 CDM 278 RC facility both 15259 15259 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 4 ORS70135 CDM 278 RC facility both 15259 15259 Gross Charge Type: NIHD_Hosp_Profee_Price Biolox Delta Ceramic C-Taper Femoral Head 36mm +7.5mm ORS70136 CDM 278 RC facility both 9468 9468 Gross Charge Type: NIHD_Hosp_Profee_Price Biolox Delta Ceramic C-Taper Femoral Head 36mm +7.5mm ORS70136 CDM 278 RC facility both 9468 9468 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE STRATAFIX 3-0 PDS 8IN DYED ORS70137 CDM 272 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price SUTURE STRATAFIX 3-0 PDS 8IN DYED ORS70137 CDM 272 RC facility both 71 71 Gross Charge Type: NIHD_Hosp_Profee_Price 2-0 Statafix Suture 9 inches ORS70138 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price 2-0 Statafix Suture 9 inches ORS70138 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price GIGLI SAW blade ORS70139 CDM 272 RC facility both 401 401 Gross Charge Type: NIHD_Hosp_Profee_Price GIGLI SAW blade ORS70139 CDM 272 RC facility both 401 401 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 22.5 TFNT0022.5 ORS70140 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 22.5 TFNT0022.5 ORS70140 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 23.0 TFNT0023.0 ORS70141 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 23.0 TFNT0023.0 ORS70141 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 21.5 OPTIC LENS ORS70142 CDM 276 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 21.5 OPTIC LENS ORS70142 CDM 276 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 22.0 OPTIC LENS ORS70143 CDM 276 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 22.0 OPTIC LENS ORS70143 CDM 276 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 21.5 ORS70144 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 21.5 ORS70144 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 25.0 TFNT3025.0 ORS70146 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 25.0 TFNT3025.0 ORS70146 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 24.0 ORS70147 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 24.0 ORS70147 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 5 LT PS ORS70148 CDM 278 RC facility both 23741 23741 Gross Charge Type: NIHD_Hosp_Profee_Price FEMORAL POSTERIOR STABILIZER SZ 5 LT PS ORS70148 CDM 278 RC facility both 23741 23741 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 5 ORS70149 CDM 278 RC facility both 15259 15259 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 5 ORS70149 CDM 278 RC facility both 15259 15259 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Asymmetric Patella sz A32mm 10mm ORS70150 CDM 278 RC facility both 5691 5691 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Asymmetric Patella sz A32mm 10mm ORS70150 CDM 278 RC facility both 5691 5691 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 5 9MM ORS70151 CDM 278 RC facility both 10753 10753 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-PS SZ 5 9MM ORS70151 CDM 278 RC facility both 10753 10753 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz3 LT CR ORS70152 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz3 LT CR ORS70152 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEG 36E ORS70153 CDM 278 RC facility both 8795 8795 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT POLYETHLENE TRIDENT 0 DEG 36E ORS70153 CDM 278 RC facility both 8795 8795 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT319.0 ORS70154 CDM 276 RC facility both 1180 1180 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT319.0 ORS70154 CDM 276 RC facility both 1180 1180 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 20.5 TFNT00.205 ORS70155 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 20.5 TFNT00.205 ORS70155 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 19.5 OPTIC LENS ORS70156 CDM 276 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 19.5 OPTIC LENS ORS70156 CDM 276 RC facility both 775 775 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1U 19.5 ORS70157 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1U 19.5 ORS70157 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 13.0 TFNT4013.0 LENS ORS70158 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 13.0 TFNT4013.0 LENS ORS70158 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 12.5 OPTIC LENS ORS70159 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 12.5 OPTIC LENS ORS70159 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price SHAVER TORPEDO HIP 4.2 x 19 cm ORS70160 CDM 272 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price SHAVER TORPEDO HIP 4.2 x 19 cm ORS70160 CDM 272 RC facility both 304 304 Gross Charge Type: NIHD_Hosp_Profee_Price KIT DISP MASTER HIP ARTHROSCOPY ORS70161 CDM 272 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price KIT DISP MASTER HIP ARTHROSCOPY ORS70161 CDM 272 RC facility both 1350 1350 Gross Charge Type: NIHD_Hosp_Profee_Price Trim-It Custom Hip Cannula ORS70162 CDM 272 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price Trim-It Custom Hip Cannula ORS70162 CDM 272 RC facility both 196 196 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 20.0 TFNT0020.0 ORS70163 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 20.0 TFNT0020.0 ORS70163 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 15.0 TFNT00U150 ORS70164 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 15.0 TFNT00U150 ORS70164 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 19.0 ORS70166 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 19.0 ORS70166 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 22.0 ORS70167 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 22.0 ORS70167 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 17.0 OPTIC LENS ORS70168 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 17.0 OPTIC LENS ORS70168 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 19.0 OPTIC LENS ORS70169 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price ACRYSOF MP FOLDABLE 19.0 OPTIC LENS ORS70169 CDM 276 RC facility both 310 310 Gross Charge Type: NIHD_Hosp_Profee_Price PolyethyleneArticular Surface LPS Flex 10mm ORS70170 CDM 278 RC facility both 2474 2474 Gross Charge Type: NIHD_Hosp_Profee_Price PolyethyleneArticular Surface LPS Flex 10mm ORS70170 CDM 278 RC facility both 2474 2474 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1U125 12.5 ORS70171 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1U125 12.5 ORS70171 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Knot Pusher / Suture Cutter with Portal Skid ORS70172 CDM 272 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price Knot Pusher / Suture Cutter with Portal Skid ORS70172 CDM 272 RC facility both 660 660 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 155X18 ORS70173 CDM 278 RC facility both 16776 16776 Gross Charge Type: NIHD_Hosp_Profee_Price RESTORATION MOD HIP SYSTEM 155X18 ORS70173 CDM 278 RC facility both 16776 16776 Gross Charge Type: NIHD_Hosp_Profee_Price LINER CEMENTLESS 48mm G ORS70174 CDM 278 RC facility both 10419 10419 Gross Charge Type: NIHD_Hosp_Profee_Price LINER CEMENTLESS 48mm G ORS70174 CDM 278 RC facility both 10419 10419 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT RESTORATION SIZE 28/54 SIZE 48G ORS70175 CDM 278 RC facility both 8209 8209 Gross Charge Type: NIHD_Hosp_Profee_Price INSERT RESTORATION SIZE 28/54 SIZE 48G ORS70175 CDM 278 RC facility both 8209 8209 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz4 LFT CR ORS70176 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz4 LFT CR ORS70176 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Symmetric Patella sz S31mm THNKS 9mm ORS70177 CDM 278 RC facility both 5691 5691 Gross Charge Type: NIHD_Hosp_Profee_Price Symmetric Patella sz S31mm THNKS 9mm ORS70177 CDM 278 RC facility both 5691 5691 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X9MM ORS70178 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X9MM ORS70178 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 2 ORS70179 CDM 278 RC facility both 15109 15109 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 2 ORS70179 CDM 278 RC facility both 15109 15109 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2 X9MM ORS70180 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2 X9MM ORS70180 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price X3 TRIATHLON INSERT CS #2 10MM ORS70182 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price X3 TRIATHLON INSERT CS #2 10MM ORS70182 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON CR FEM COMPONENT - BEADED w/PA ORS70183 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price TRIATHLON CR FEM COMPONENT - BEADED w/PA ORS70183 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price "3DMax Light Mesh, Left, Size M, 3.1"" x 5.3""" ORS70184 CDM 278 RC facility both 1007 1007 Gross Charge Type: NIHD_Hosp_Profee_Price "3DMax Light Mesh, Left, Size M, 3.1"" x 5.3""" ORS70184 CDM 278 RC facility both 1007 1007 Gross Charge Type: NIHD_Hosp_Profee_Price "3DMax Light Mesh, Right, Size M, 3.1"" x 5.3""" ORS70185 CDM 278 RC facility both 879 879 Gross Charge Type: NIHD_Hosp_Profee_Price "3DMax Light Mesh, Right, Size M, 3.1"" x 5.3""" ORS70185 CDM 278 RC facility both 879 879 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 20.5 ORS70186 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 20.5 ORS70186 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2 X 14MM ORS70187 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 2 X 14MM ORS70187 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz6 RT CR ORS70188 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz6 RT CR ORS70188 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 5 X12MM ORS70189 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 5 X12MM ORS70189 CDM 278 RC facility both 11340 11340 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 7 ORS70190 CDM 278 RC facility both 13327 13327 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 7 ORS70190 CDM 278 RC facility both 13327 13327 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz6 LFT CR ORS70191 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz6 LFT CR ORS70191 CDM 278 RC facility both 23494 23494 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 6 ORS70192 CDM 278 RC facility both 15259 15259 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Tibial Component size 6 ORS70192 CDM 278 RC facility both 15259 15259 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 17.0 TFNT0017.0 ORS70193 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 17.0 TFNT0017.0 ORS70193 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 18.0 TFNT0018.0 ORS70194 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 18.0 TFNT0018.0 ORS70194 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 21.0 ORS70195 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 21.0 ORS70195 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz5 RT CR ORS70196 CDM 278 RC facility both 20898 20898 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz5 RT CR ORS70196 CDM 278 RC facility both 20898 20898 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS FIBERTAK 1.8MM #2 suture ORS70200 CDM 278 RC facility both 5761 5761 Gross Charge Type: NIHD_Hosp_Profee_Price KNOTLESS FIBERTAK 1.8MM #2 suture ORS70200 CDM 278 RC facility both 5761 5761 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTTO 23.5 PanOptix Lens ORS70201 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTTO 23.5 PanOptix Lens ORS70201 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price PMMA Single Piece IOL Lens 16.5 ORS70202 CDM 276 RC facility both 533 533 Gross Charge Type: NIHD_Hosp_Profee_Price PMMA Single Piece IOL Lens 16.5 ORS70202 CDM 276 RC facility both 533 533 Gross Charge Type: NIHD_Hosp_Profee_Price Integra Matrix Wound Dressing ORS70203 CDM 272 RC facility both 6487 6487 Gross Charge Type: NIHD_Hosp_Profee_Price Integra Matrix Wound Dressing ORS70203 CDM 272 RC facility both 6487 6487 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL CNAOTO LENS 8.5 ORS70204 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL CNAOTO LENS 8.5 ORS70204 CDM 276 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price "#2 FIBERSNARE,#2 FIBERWIRE, 26 IN" ORS70205 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price "#2 FIBERSNARE,#2 FIBERWIRE, 26 IN" ORS70205 CDM 272 RC facility both 61 61 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Non-Locking Screw 3.5 Hex 25mm ORS70207 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Non-Locking Screw 3.5 Hex 25mm ORS70207 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Non-Locking Screw 3.5 Hex 40mm ORS70208 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Non-Locking Screw 3.5 Hex 40mm ORS70208 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5 mm Central Screw 3.5 Hex 50mm ORS70209 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5 mm Central Screw 3.5 Hex 50mm ORS70209 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Locking Screw 3.5 Hex 40mm ORS70210 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Locking Screw 3.5 Hex 40mm ORS70210 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Locking Screw 3.5 Hex 25mm ORS70211 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Locking Screw 3.5 Hex 25mm ORS70211 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Humeral Stem - Mini 4mm ORS70212 CDM 278 RC facility both 9951 9951 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Humeral Stem - Mini 4mm ORS70212 CDM 278 RC facility both 9951 9951 Gross Charge Type: NIHD_Hosp_Profee_Price Versa-Dial® Glenosphere Standard 36mm ORS70213 CDM 278 RC facility both 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price Versa-Dial® Glenosphere Standard 36mm ORS70213 CDM 278 RC facility both 3143 3143 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder System Mini Humeral Tray 5mm Thick 40mm ORS70214 CDM 278 RC facility both 4976 4976 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder System Mini Humeral Tray 5mm Thick 40mm ORS70214 CDM 278 RC facility both 4976 4976 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder System Vivacit-E® Bearing 3mm Thick 36mm ORS70215 CDM 278 RC facility both 3404 3404 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder System Vivacit-E® Bearing 3mm Thick 36mm ORS70215 CDM 278 RC facility both 3404 3404 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Locking Screw 3.5 Hex 45mm ORS70216 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price 4.75 mm Fixed Locking Screw 3.5 Hex 45mm ORS70216 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price "Suture Undyed Ethicon Monocryl Monofilament Absorbable Prime Reverse Cutting 3/8C 5-0 P-3 18""" ORS70220 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price "Suture Undyed Ethicon Monocryl Monofilament Absorbable Prime Reverse Cutting 3/8C 5-0 P-3 18""" ORS70220 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTTO 17.0 Panoptix Lens ORS70226 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTTO 17.0 Panoptix Lens ORS70226 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon MN6AD1 16.5 ORS70227 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon MN6AD1 16.5 ORS70227 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon MN6AD1 16.0 ORS70228 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon MN6AD1 16.0 ORS70228 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Accolade 132 degree size 6 Hip Stem ORS70229 CDM 278 RC facility both 13528 13528 Gross Charge Type: NIHD_Hosp_Profee_Price Accolade 132 degree size 6 Hip Stem ORS70229 CDM 278 RC facility both 13528 13528 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon PanOptix CNWTTO 18.0 lens ORS70230 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon PanOptix CNWTTO 18.0 lens ORS70230 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon PanOptix CNWTTO 24.5 Lens ORS70231 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon PanOptix CNWTTO 24.5 Lens ORS70231 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Single Piece SA60AT 31.0 Lens ORS70232 CDM 276 RC facility both 273 273 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Single Piece SA60AT 31.0 Lens ORS70232 CDM 276 RC facility both 273 273 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL CNWTTO PANOPTIX LENS 15.0 ORS70233 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL CNWTTO PANOPTIX LENS 15.0 ORS70233 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE PLANTAR LAPIDUS SHORT RIGHT ORS70234 CDM 278 RC facility both 3916 3916 Gross Charge Type: NIHD_Hosp_Profee_Price PLATE PLANTAR LAPIDUS SHORT RIGHT ORS70234 CDM 278 RC facility both 3916 3916 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 20 mm low profile cortical lock screw ORS70235 CDM 278 RC facility both 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 20 mm low profile cortical lock screw ORS70235 CDM 278 RC facility both 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 24 mm low profile cortical lock screw ORS70236 CDM 278 RC facility both 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 24 mm low profile cortical lock screw ORS70236 CDM 278 RC facility both 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 28 mm low profile cortical lock screw ORS70237 CDM 278 RC facility both 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 28 mm low profile cortical lock screw ORS70237 CDM 278 RC facility both 393 393 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 20mm low profile Titanium Cortical Screw ORS70238 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 20mm low profile Titanium Cortical Screw ORS70238 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 26 mm low profile Titanium Cortical Screw ORS70239 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 26 mm low profile Titanium Cortical Screw ORS70239 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 36 mm low profile Titanium Cortical Screw ORS70240 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 36 mm low profile Titanium Cortical Screw ORS70240 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0 x 34 mm low Profile Tit Cancellous Screw ORS70241 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price 4.0 x 34 mm low Profile Tit Cancellous Screw ORS70241 CDM 278 RC facility both 157 157 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4 MM ORS70243 CDM 272 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT 4 MM ORS70243 CDM 272 RC facility both 328 328 Gross Charge Type: NIHD_Hosp_Profee_Price TACK BB THREADED ORS70244 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price TACK BB THREADED ORS70244 CDM 272 RC facility both 256 256 Gross Charge Type: NIHD_Hosp_Profee_Price Guidewire W-Trocar Tip 062 In ORS70245 CDM 272 RC facility both 236 236 Gross Charge Type: NIHD_Hosp_Profee_Price Guidewire W-Trocar Tip 062 In ORS70245 CDM 272 RC facility both 236 236 Gross Charge Type: NIHD_Hosp_Profee_Price Newton Straight guide wire 0.035x 260 ORS70246 CDM 272 RC facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price Newton Straight guide wire 0.035x 260 ORS70246 CDM 272 RC facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price Newton curved guide wire 0.035 x 145 ORS70247 CDM 272 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price Newton curved guide wire 0.035 x 145 ORS70247 CDM 272 RC facility both 43 43 Gross Charge Type: NIHD_Hosp_Profee_Price Newton Straight guide wire 0.035 x 145 ORS70248 CDM 272 RC facility both 44 44 Gross Charge Type: NIHD_Hosp_Profee_Price Newton Straight guide wire 0.035 x 145 ORS70248 CDM 272 RC facility both 44 44 Gross Charge Type: NIHD_Hosp_Profee_Price Newton Curved guide wire 0.035 x 145 x 15 ORS70249 CDM 272 RC facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price Newton Curved guide wire 0.035 x 145 x 15 ORS70249 CDM 272 RC facility both 46 46 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 18.0 ORS70250 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 18.0 ORS70250 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 18.5 ORS70251 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 18.5 ORS70251 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 19.5 ORS70253 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 19.5 ORS70253 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 20.2 ORS70254 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 20.2 ORS70254 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 20.5 ORS70255 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 20.5 ORS70255 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 21.0 ORS70256 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 21.0 ORS70256 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 21.5 ORS70257 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 21.5 ORS70257 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 22.0 ORS70258 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 22.0 ORS70258 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 22.5 ORS70259 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 22.5 ORS70259 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 23.0 ORS70260 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 23.0 ORS70260 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 23.5 ORS70261 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 23.5 ORS70261 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 24.0 ORS70262 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 24.0 ORS70262 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 24.5 ORS70263 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 24.5 ORS70263 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 25.0 ORS70264 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 25.0 ORS70264 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 25.5 ORS70265 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 25.5 ORS70265 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 26.0 ORS70266 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT3 26.0 ORS70266 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 18.5 ORS70268 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 18.5 ORS70268 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 19.5 ORS70270 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 19.5 ORS70270 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 20.0 ORS70271 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 20.0 ORS70271 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 20.5 ORS70272 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 20.5 ORS70272 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 21.0 ORS70273 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 21.0 ORS70273 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 22.5 ORS70276 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 22.5 ORS70276 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 23.0 ORS70277 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 23.0 ORS70277 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 24.5 ORS70280 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 24.5 ORS70280 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 25.0 ORS70281 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 25.0 ORS70281 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 25.5 ORS70282 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price Lens Multifocal MN6AD1 25.5 ORS70282 CDM 276 RC facility both 895 895 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 18.5 ORS70284 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 18.5 ORS70284 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 19.0 ORS70285 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 19.0 ORS70285 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 19.5 ORS70286 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 19.5 ORS70286 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 20.0 ORS70287 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 20.0 ORS70287 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 21.5 ORS70290 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 21.5 ORS70290 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 22.0 ORS70291 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 22.0 ORS70291 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 22.5 ORS70292 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 22.5 ORS70292 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 23.0 ORS70293 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 23.0 ORS70293 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 24.0 ORS70295 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 24.0 ORS70295 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 25.0 ORS70297 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 25.0 ORS70297 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 25.5 ORS70298 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 25.5 ORS70298 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 6 X10MM ORS70299 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 6 X10MM ORS70299 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 20.5 ORS70300 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 20.5 ORS70300 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 21.0 ORS70301 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 21.0 ORS70301 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 21.5 ORS70302 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 21.5 ORS70302 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 22.0 ORS70303 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 22.0 ORS70303 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 22.5 ORS70304 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 22.5 ORS70304 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 23.0 ORS70305 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 23.0 ORS70305 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 23.5 ORS70306 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 23.5 ORS70306 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 24.0 ORS70307 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 24.0 ORS70307 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 24.5 ORS70308 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 24.5 ORS70308 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 25.0 ORS70309 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 25.0 ORS70309 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 25.5 ORS70310 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 25.5 ORS70310 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 26.0 ORS70311 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 26.0 ORS70311 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 18.0 ORS70312 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 18.0 ORS70312 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 18.5 ORS70313 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 18.5 ORS70313 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 19.0 ORS70314 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 19.0 ORS70314 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 19.5 ORS70315 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 19.5 ORS70315 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 20.0 ORS70316 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT4 20.0 ORS70316 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 18.0 ORS70317 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 18.0 ORS70317 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 18.5 ORS70318 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 18.5 ORS70318 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 19.0 ORS70319 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 19.0 ORS70319 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 19.5 ORS70320 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 19.5 ORS70320 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 20.0 ORS70321 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 20.0 ORS70321 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 20.5 ORS70322 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 20.5 ORS70322 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 21.0 ORS70323 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 21.0 ORS70323 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 21.5 ORS70324 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 21.5 ORS70324 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 22.0 ORS70325 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 22.0 ORS70325 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 22.5 ORS70326 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 22.5 ORS70326 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 23.0 ORS70327 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 23.0 ORS70327 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 23.5 ORS70328 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 23.5 ORS70328 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 24.0 ORS70329 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 24.0 ORS70329 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 24.5 ORS70330 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 24.5 ORS70330 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 25.0 ORS70331 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 25.0 ORS70331 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 25.5 ORS70332 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 25.5 ORS70332 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 26.0 ORS70333 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price IOL TORIC SN6AT5 26.0 ORS70333 CDM 276 RC facility both 505 505 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz5 LFT CR ORS70334 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz5 LFT CR ORS70334 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X14MM ORS70335 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 4 X14MM ORS70335 CDM 278 RC facility both 11010 11010 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 18.0 PanOptix Lens ORS70336 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 18.0 PanOptix Lens ORS70336 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price CNWTT3 PanOptix Trifocal IOL 18.5 ORS70337 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price CNWTT3 PanOptix Trifocal IOL 18.5 ORS70337 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 19.0 PanOptix Lens ORS70338 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 19.0 PanOptix Lens ORS70338 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 19.5 PanOptix Lens ORS70339 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 19.5 PanOptix Lens ORS70339 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 20.0 PanOptix Lens ORS70340 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 20.0 PanOptix Lens ORS70340 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 20.5 PanOptix Lens ORS70341 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 20.5 PanOptix Lens ORS70341 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 21.0 PanOptix Lens ORS70342 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 21.0 PanOptix Lens ORS70342 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 21.5 PanOptix Lens ORS70343 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 21.5 PanOptix Lens ORS70343 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 22.0 PanOptix Lens ORS70344 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 22.0 PanOptix Lens ORS70344 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 22.5 PanOptix Lens ORS70345 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 22.5 PanOptix Lens ORS70345 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 23.0 PanOptix Lens ORS70346 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 23.0 PanOptix Lens ORS70346 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 23.5 PanOptix Lens ORS70347 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 23.5 PanOptix Lens ORS70347 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 24.0 PanOptix Lens ORS70348 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 24.0 PanOptix Lens ORS70348 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 24.5 PanOptix Lens ORS70349 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 24.5 PanOptix Lens ORS70349 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 25.0 PanOptix Lens ORS70350 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 25.0 PanOptix Lens ORS70350 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 25.5 PanOptix Lens ORS70351 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon CNWTT3 25.5 PanOptix Lens ORS70351 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 18.0 ORS70352 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 18.0 ORS70352 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 18.5 ORS70353 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 18.5 ORS70353 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 19.0 ORS70354 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 19.0 ORS70354 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 19.5 ORS70355 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 19.5 ORS70355 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 20.0 ORS70356 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 20.0 ORS70356 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 20.5 ORS70357 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 20.5 ORS70357 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 21.0 ORS70358 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 21.0 ORS70358 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 21.5 ORS70359 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 21.5 ORS70359 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 22.0 ORS70360 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 22.0 ORS70360 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 22.5 ORS70361 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 22.5 ORS70361 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 23.0 ORS70362 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 23.0 ORS70362 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 23.5 ORS70363 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 23.5 ORS70363 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 24.5 ORS70365 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 24.5 ORS70365 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 25.0 ORS70366 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 25.0 ORS70366 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 25.5 ORS70367 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 25.5 ORS70367 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 19.5 ORS70368 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 19.5 ORS70368 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 20.0 ORS70369 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 20.0 ORS70369 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 20.5 ORS70370 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 20.5 ORS70370 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 21.0 ORS70371 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 21.0 ORS70371 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 21.5 ORS70372 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 21.5 ORS70372 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 22.0 ORS70373 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 22.0 ORS70373 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 22.5 ORS70374 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 22.5 ORS70374 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 23.0 ORS70375 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 23.0 ORS70375 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 23.5 ORS70376 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 23.5 ORS70376 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 24.0 ORS70377 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 24.0 ORS70377 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 24.5 ORS70378 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 24.5 ORS70378 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 25.0 ORS70379 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 25.0 ORS70379 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 25.5 ORS70380 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 25.5 ORS70380 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 26.0 ORS70381 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 26.0 ORS70381 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT6 16.5 ORS70382 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT6 16.5 ORS70382 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T4 25.5 ORS70383 CDM 276 RC facility both 1205 1205 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T4 25.5 ORS70383 CDM 276 RC facility both 1205 1205 Gross Charge Type: NIHD_Hosp_Profee_Price "Sonicision 7 Dissector, Curved Jaw, 39 cm" ORS70384 CDM 272 RC facility both 1679 1679 Gross Charge Type: NIHD_Hosp_Profee_Price "Sonicision 7 Dissector, Curved Jaw, 39 cm" ORS70384 CDM 272 RC facility both 1679 1679 Gross Charge Type: NIHD_Hosp_Profee_Price NCIRCLE TIPLESS STONE EXTRACTOR;G17627;Basket Diameter 1 cm;Length 115 cm;French Size 3 Fr ORS70385 CDM 272 RC facility both 679 679 Gross Charge Type: NIHD_Hosp_Profee_Price NCIRCLE TIPLESS STONE EXTRACTOR;G17627;Basket Diameter 1 cm;Length 115 cm;French Size 3 Fr ORS70385 CDM 272 RC facility both 679 679 Gross Charge Type: NIHD_Hosp_Profee_Price "OPEN-END URETERAL CATHETER, 5F X 70CM" ORS70386 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price "OPEN-END URETERAL CATHETER, 5F X 70CM" ORS70386 CDM 272 RC facility both 66 66 Gross Charge Type: NIHD_Hosp_Profee_Price 0 Polysorb CTXB blunt needle 36 in Suture ORS70387 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price 0 Polysorb CTXB blunt needle 36 in Suture ORS70387 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price PATHFINDER PLUS™ ENDOSCOPIC IRRIGATORS ORS70388 CDM 272 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price PATHFINDER PLUS™ ENDOSCOPIC IRRIGATORS ORS70388 CDM 272 RC facility both 112 112 Gross Charge Type: NIHD_Hosp_Profee_Price Endoscopic Sureseal Valves with Adapter ORS70389 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Endoscopic Sureseal Valves with Adapter ORS70389 CDM 272 RC facility both 47 47 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT6 15.5 ORS70390 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT6 15.5 ORS70390 CDM 276 RC facility both 1015 1015 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 17.5 ORS70391 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL PANOPTIX LENS 17.5 ORS70391 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 17.0 ORS70392 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 17.0 ORS70392 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERSTITCH CURVED WITH 2-4 FIBERWIRE ORS70393 CDM 278 RC facility both 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price FIBERSTITCH CURVED WITH 2-4 FIBERWIRE ORS70393 CDM 278 RC facility both 1728 1728 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 24.0 ORS70395 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 24.0 ORS70395 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 25.0 ORS70397 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 25.0 ORS70397 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 25.5 ORS70398 CDM 278 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 25.5 ORS70398 CDM 278 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 26.0 ORS70399 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 26.0 ORS70399 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 26.5 ORS70400 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T5 26.5 ORS70400 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 24.0 ORS70401 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 24.0 ORS70401 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 24.5 ORS70402 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 24.5 ORS70402 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 25.0 ORS70403 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 25.0 ORS70403 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 25.5 ORS70404 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 25.5 ORS70404 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 26.0 ORS70405 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Toric IOL CNW0T6 26.0 ORS70405 CDM 276 RC facility both 1263 1263 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 16.5 ORS70406 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 16.5 ORS70406 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X75MM TI CANNULATED SCREW 602875 ORS70407 CDM 278 RC facility both 694 694 Gross Charge Type: NIHD_Hosp_Profee_Price 6.5X75MM TI CANNULATED SCREW 602875 ORS70407 CDM 278 RC facility both 694 694 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon IOL Lens SY60WF 9.5 ORS70408 CDM 276 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon IOL Lens SY60WF 9.5 ORS70408 CDM 276 RC facility both 335 335 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon PanOptix Toric CNWTT3 10.0 ORS70410 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon PanOptix Toric CNWTT3 10.0 ORS70410 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz8 RT CR ORS70411 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Cruciate Retaining Femoral sz8 RT CR ORS70411 CDM 278 RC facility both 20521 20521 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Asymmetric Patella sz A35MM 10MM ORS70412 CDM 278 RC facility both 4970 4970 Gross Charge Type: NIHD_Hosp_Profee_Price Triathalon Asymmetric Patella sz A35MM 10MM ORS70412 CDM 278 RC facility both 4970 4970 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 7X14MM ORS70413 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 7X14MM ORS70413 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 16.0 ORS70414 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT5 16.0 ORS70414 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-6HOLE/RIGHT ORS70415 CDM 278 RC facility both 2651 2651 Gross Charge Type: NIHD_Hosp_Profee_Price SUPERIOR PLATE DECREASED-6HOLE/RIGHT ORS70415 CDM 278 RC facility both 2651 2651 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT AO 0.26X135MM ORS70416 CDM 272 RC facility both 627 627 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT AO 0.26X135MM ORS70416 CDM 272 RC facility both 627 627 Gross Charge Type: NIHD_Hosp_Profee_Price Clavicle Locking Screw 3.5 x 12 ORS70418 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price Clavicle Locking Screw 3.5 x 12 ORS70418 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price Clavicle Locking Screw 3.5 x 14 ORS70419 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price Clavicle Locking Screw 3.5 x 14 ORS70419 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price Clavicle Non Locking Screw 3.5 X 14 ORS70421 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price Clavicle Non Locking Screw 3.5 X 14 ORS70421 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price PanOptix® Intraocular Lens SA60AT 28.0 ORS70422 CDM 276 RC facility both 273 273 Gross Charge Type: NIHD_Hosp_Profee_Price PanOptix® Intraocular Lens SA60AT 28.0 ORS70422 CDM 276 RC facility both 273 273 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Bearing 36mm Dia ORS70423 CDM 278 RC facility both 3404 3404 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Bearing 36mm Dia ORS70423 CDM 278 RC facility both 3404 3404 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CENTRAL RVS 6.5X45MM ORS70424 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price SCREW CENTRAL RVS 6.5X45MM ORS70424 CDM 278 RC facility both 262 262 Gross Charge Type: NIHD_Hosp_Profee_Price Shoulder AC Connector ORS70425 CDM 278 RC facility both 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price Shoulder AC Connector ORS70425 CDM 278 RC facility both 1650 1650 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Bearing 3mm 36mm Dia ORS70426 CDM 278 RC facility both 3404 3404 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Bearing 3mm 36mm Dia ORS70426 CDM 278 RC facility both 3404 3404 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Drill 2.7mm ORS70427 CDM 272 RC facility both 340 340 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Drill 2.7mm ORS70427 CDM 272 RC facility both 340 340 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Reamer Guide Screw ORS70428 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Reamer Guide Screw ORS70428 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Reamer Guide Bushing ORS70429 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price Comprehensive Reverse Shoulder Reamer Guide Bushing ORS70429 CDM 278 RC facility both 183 183 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 1 RT ORS70430 CDM 278 RC facility both 13497 13497 Gross Charge Type: NIHD_Hosp_Profee_Price CRUCIATE RETAINING FEMORAL SZ 1 RT ORS70430 CDM 278 RC facility both 13497 13497 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 6.0 ORS70433 CDM 272 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price CLAREON IOL LENS 6.0 ORS70433 CDM 272 RC facility both 525 525 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 7X9MM ORS70435 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price TIBIAL BEARING INSERT-CS SZ 7X9MM ORS70435 CDM 278 RC facility both 9904 9904 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT AO 2.0mmx135mm ORS70436 CDM 272 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price DRILL BIT AO 2.0mmx135mm ORS70436 CDM 272 RC facility both 338 338 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 16 mm Locking Screw ORS70437 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price 3.5 x 16 mm Locking Screw ORS70437 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L18" ORS70438 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L18" ORS70438 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L55" ORS70439 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L55" ORS70439 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 FULL THREAD 3.5mm / L8mm ORS70444 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price LOCKING SCREW T10 FULL THREAD 3.5mm / L8mm ORS70444 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L16" ORS70446 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L16" ORS70446 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L30" ORS70447 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L30" ORS70447 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L36" ORS70448 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L36" ORS70448 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L50" ORS70450 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price "Bone Screw VariAx2 T10, Full Thread, 3.5mm / L50" ORS70450 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price Locking Screw 2.7mm x 12mm ORS70452 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price Locking Screw 2.7mm x 12mm ORS70452 CDM 278 RC facility both 414 414 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 FULL THREAD 2.7mm / L8mm ORS70453 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price BONE SCREW T10 FULL THREAD 2.7mm / L8mm ORS70453 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price Non-Locking Screw 2.7mm x 20mm ORS70454 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price Non-Locking Screw 2.7mm x 20mm ORS70454 CDM 278 RC facility both 225 225 Gross Charge Type: NIHD_Hosp_Profee_Price Parietene DS Composite Mesh 30x20cm ORS70457 CDM 278 RC facility both 3928 3928 Gross Charge Type: NIHD_Hosp_Profee_Price Parietene DS Composite Mesh 30x20cm ORS70457 CDM 278 RC facility both 3928 3928 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT6 23.0 ORS70458 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT6 23.0 ORS70458 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 11.0 ORS70459 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Clareon Panoptix Toric IOL CNWTT4 11.0 ORS70459 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 15.0 ORS70461 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 15.0 ORS70461 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 16.0 ORS70462 CDM 272 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 16.0 ORS70462 CDM 272 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 17.5 ORS70463 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price AcrySof IQ PanOptix Trifocal IOL 17.5 ORS70463 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Large PEC Button Kit ORS70464 CDM 278 RC facility both 4321 4321 Gross Charge Type: NIHD_Hosp_Profee_Price Large PEC Button Kit ORS70464 CDM 278 RC facility both 4321 4321 Gross Charge Type: NIHD_Hosp_Profee_Price "SET, RENAL, DIALATOR, AMPLATZ" ORS70465 CDM 272 RC facility both 864 864 Gross Charge Type: NIHD_Hosp_Profee_Price "SET, RENAL, DIALATOR, AMPLATZ" ORS70465 CDM 272 RC facility both 864 864 Gross Charge Type: NIHD_Hosp_Profee_Price E0226 RBC CPDA1 500 LR P01961 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E0226 RBC CPDA1 500 LR P01961 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E4544 Aph RBC ACDA AS3 LR 1 P019610 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4544 Aph RBC ACDA AS3 LR 1 P019610 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4545 Aph RBC ACDA AS3 LR 2 P019611 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4545 Aph RBC ACDA AS3 LR 2 P019611 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E0332 RBC CPD AS1 500 LR Irr P01962_E0332 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E0332 RBC CPD AS1 500 LR Irr P01962_E0332 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4351 Aph Dv RBC ACDA LR 1 Open P01962_E4351 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E4351 Aph Dv RBC ACDA LR 1 Open P01962_E4351 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E0336 RBC CPD AS1 500 LR P01963 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E0336 RBC CPD AS1 500 LR P01963 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E0379 RBC CP2D AS3 500 LR Irr P01964 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E0379 RBC CP2D AS3 500 LR Irr P01964 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E0382 RBC CP2D AS3 500 LR P01965 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E0382 RBC CP2D AS3 500 LR P01965 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E4531 Aph RBC ACDA AS1 LR P01966 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E4531 Aph RBC ACDA AS1 LR P01966 CDM 390 RC facility both 300.25 300.25 Gross Charge Type: NIHD_Hosp_Profee_Price E4532 Aph RBC ACDA AS1 LR 1 P01967 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4532 Aph RBC ACDA AS1 LR 1 P01967 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4533 Aph RBC ACDA AS1 LR 2 P01968 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4533 Aph RBC ACDA AS1 LR 2 P01968 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4543 Aph RBC ACDA AS3 LR P01969 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E4543 Aph RBC ACDA AS3 LR P01969 CDM 390 RC facility both 258 258 Gross Charge Type: NIHD_Hosp_Profee_Price E3587 Pooled Cryo <18C P90121_E3587 CDM 390 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price E3587 Pooled Cryo <18C P90121_E3587 CDM 390 RC facility both 450 450 Gross Charge Type: NIHD_Hosp_Profee_Price E3591 Thawed Pooled Cryo P90121_E3591 CDM 390 RC facility both 474 474 Gross Charge Type: NIHD_Hosp_Profee_Price E3591 Thawed Pooled Cryo P90121_E3591 CDM 390 RC facility both 474 474 Gross Charge Type: NIHD_Hosp_Profee_Price E3087 Aph Plt ACDA LR 1 P90351 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price E3087 Aph Plt ACDA LR 1 P90351 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price E3088 Aph Plt ACDA LR 2 P90352 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price E3088 Aph Plt ACDA LR 2 P90352 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price E3089 Aph Plt ACDA LR 3 P90353 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price E3089 Aph Plt ACDA LR 3 P90353 CDM 390 RC facility both 720 720 Gross Charge Type: NIHD_Hosp_Profee_Price E1314 Thawed Aph FFP ACDA 200-400 mL P90591 CDM 390 RC facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price E1314 Thawed Aph FFP ACDA 200-400 mL P90591 CDM 390 RC facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price E7731 Thawed Aph Plasma ACDA RT<24Fr<24 P90592 CDM 390 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price E7731 Thawed Aph Plasma ACDA RT<24Fr<24 P90592 CDM 390 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price E7751 Thawed Aph Plasma RT <24Fr<24 2 P90593 CDM 390 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price E7751 Thawed Aph Plasma RT <24Fr<24 2 P90593 CDM 390 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price E7752 Thawed Aph Plas ACDA RT<24Frz<24 3 P90594 CDM 390 RC facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price E7752 Thawed Aph Plas ACDA RT<24Frz<24 3 P90594 CDM 390 RC facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price E7753 Thawed Aph Plasma RT <24Fr<24 4 P90595 CDM 390 RC facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price E7753 Thawed Aph Plasma RT <24Fr<24 4 P90595 CDM 390 RC facility both 97 97 Gross Charge Type: NIHD_Hosp_Profee_Price E2701 Thawed Plasma CPD <24h P90596 CDM 390 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price E2701 Thawed Plasma CPD <24h P90596 CDM 390 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price P9612 Catheterize for urine spec TechFee P96121 CDM 450 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price P9612 Catheterize for urine spec TechFee P96121 CDM 450 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price P9612 OBS ONLY CATHETERIZE FOR URINE SPEC CHARGE P96122 CDM 761 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price P9612 OBS ONLY CATHETERIZE FOR URINE SPEC CHARGE P96122 CDM 761 RC facility both 92 92 Gross Charge Type: NIHD_Hosp_Profee_Price Pediarix (DTaP/HepB/IPV) Vaccine [INYO] PEDS CDM 58160-0811-52 NDC facility both 0.5 ML 858.43 858.43 Gross Charge Type: Pharmacy diphtheria/tetanus/pertussis (DTaP) ped 25 units-10 units-58 mcg/0.5 mL Sus UD [INYO] PEDSDTaP CDM 58160-0810-11 NDC facility both 0.5 ML 248.97 248.97 Gross Charge Type: Pharmacy diphtheria/tetanus/pertussis (DTaP) ped 25 units-10 units-58 mcg/0.5 mL Sus UD [INYO] PEDSDTaP CDM 58160-0810-52 NDC facility both 0.5 ML 248.97 248.97 Gross Charge Type: Pharmacy Q0091 Obtaining screen pap smear Q0091 CDM 521 RC Q0091 HCPCS facility both 79 79 Gross Charge Type: NIHD_RHC_Price Q0091 Obtaining screen pap smear Q0091 CDM 521 RC Q0091 HCPCS facility both 79 79 Gross Charge Type: NIHD_Clinic_Price Fern Test POCT Q01141 CDM 300 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price Fern Test POCT Q01141 CDM 300 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price Fern Test POC (RE) Q01142 CDM 300 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price Fern Test POC (RE) Q01142 CDM 300 RC facility both 67 67 Gross Charge Type: NIHD_Hosp_Profee_Price Q0220 EVUSHELD cilgavimab-tixagevimab 150 mg/1.5 mL-150 mg/1.5 mL Sol Q0220 CDM 636 RC Q0220 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_RHC_Price Q0220 EVUSHELD cilgavimab-tixagevimab 150 mg/1.5 mL-150 mg/1.5 mL Sol Q0220 CDM 636 RC Q0220 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price Q0221 EVUSHELD cilgavimab-tixagevimab 300 mg/1.5 mL- 300mg /1.5 mL Sol Q0221 CDM 636 RC Q0221 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_RHC_Price Q0221 EVUSHELD cilgavimab-tixagevimab 300 mg/1.5 mL- 300mg /1.5 mL Sol Q0221 CDM 636 RC Q0221 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price Q3014 Telemedicine Site Fee Q3014 CDM 521 RC Q3014 HCPCS facility both 116 116 Gross Charge Type: NIHD_RHC_Price "Q4006 Cast supplies, long arm cast, adult (11 years +) fiberglass" Q4006 CDM 521 RC Q4006 HCPCS facility both 103 103 Gross Charge Type: NIHD_Clinic_Price "Q4008 Cast supplies, long arm cast, pediatric (0-10 years) fiberglass" Q4008 CDM 521 RC Q4008 HCPCS facility both 66 66 Gross Charge Type: NIHD_Clinic_Price "Q4010 Cast supplies, short arm cast, adult (11 years +), fiberglass" Q4010 CDM 521 RC Q4010 HCPCS facility both 79 79 Gross Charge Type: NIHD_Clinic_Price "Q4012 Cast supplies, short arm cast, pediatric (0-10 years), fiberglass" Q4012 CDM 521 RC Q4012 HCPCS facility both 50 50 Gross Charge Type: NIHD_Clinic_Price "Q4016 Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberg" Q4016 CDM 521 RC Q4016 HCPCS facility both 83 83 Gross Charge Type: NIHD_Clinic_Price "Q4018 Cast supplies, long arm splint, adult (11 years +), fiberglass" Q4018 CDM 521 RC Q4018 HCPCS facility both 85 85 Gross Charge Type: NIHD_Clinic_Price "Q4020 Cast supplies, long arm splint, pediatric (0-10 years), fiberglass" Q4020 CDM 521 RC Q4020 HCPCS facility both 49 49 Gross Charge Type: NIHD_Clinic_Price "Q4022 Cast supplies, short arm splint, adult (11 years +), fiberglass" Q4022 CDM 521 RC Q4022 HCPCS facility both 79 79 Gross Charge Type: NIHD_Clinic_Price "Q4032 Cast supplies, long leg cast, pediatric (0-10 years), fiberglass" Q4032 CDM 521 RC Q4032 HCPCS facility both 103 103 Gross Charge Type: NIHD_Clinic_Price "Q4036 Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass" Q4036 CDM 521 RC Q4036 HCPCS facility both 101 101 Gross Charge Type: NIHD_Clinic_Price "Q4038 Cast supplies, short leg cast, adult (11 years +), fiberglass" Q4038 CDM 521 RC Q4038 HCPCS facility both 141 141 Gross Charge Type: NIHD_Clinic_Price "Q4040 Cast supplies, short leg cast, pediatric (0-10 years), fiberglass" Q4040 CDM 521 RC Q4040 HCPCS facility both 82 82 Gross Charge Type: NIHD_Clinic_Price "Q4042 Cast supplies, long leg splint, adult (11 years +), fiberglass" Q4042 CDM 521 RC Q4042 HCPCS facility both 140 140 Gross Charge Type: NIHD_RHC_Price "Q4046 Cast supplies, short leg splint, adult (11 years +), fiberglass" Q4046 CDM 521 RC Q4046 HCPCS facility both 72 72 Gross Charge Type: NIHD_Clinic_Price Q4195 Dressing PURAPLY 2x4 Q4195 CDM 278 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price Q4195 Dressing PURAPLY 2x4 Q4195 CDM 278 RC facility both 2849 2849 Gross Charge Type: NIHD_Hosp_Profee_Price Q4196 Puraply AM 5x5 Q4196 CDM 636 RC facility both 8246 8246 Gross Charge Type: NIHD_Hosp_Profee_Price Q4196 Puraply AM 5x5 Q4196 CDM 636 RC facility both 8246 8246 Gross Charge Type: NIHD_Hosp_Profee_Price Q4196 Puraply AM 2x4 Q41963 CDM 636 RC facility both 2488 2488 Gross Charge Type: NIHD_Hosp_Profee_Price Q4196 Puraply AM 2x4 Q41963 CDM 636 RC facility both 2488 2488 Gross Charge Type: NIHD_Hosp_Profee_Price Q4196 Puraply AM Q41969 CDM 636 RC facility both 2522 2522 Gross Charge Type: NIHD_Hosp_Profee_Price Q4196 Puraply AM Q41969 CDM 636 RC facility both 2522 2522 Gross Charge Type: NIHD_Hosp_Profee_Price "Q9991 Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg" Q9991 CDM 999 RC Q9991 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "Q9991 Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg" Q9991 CDM 999 RC Q9991 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "Q9992 Injection, buprenorphine extended-release (sublocade), greater than 100 mg" Q9992 CDM 999 RC Q9992 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_RHC_Price "Q9992 Injection, buprenorphine extended-release (sublocade), greater than 100 mg" Q9992 CDM 999 RC Q9992 HCPCS facility both 0.01 0.01 Gross Charge Type: NIHD_Clinic_Price "RSV vaccine preF3, recombinant preservative-free 120 mcg Pow" rhc10923 CDM 58160-0848-11 NDC facility both 1 EA 2016 2016 Gross Charge Type: Pharmacy "J0129 Injection, abatacept, 10 mg" RXC01745 CDM 636 RC J0129 HCPCS facility both 535 535 Gross Charge Type: NIHD_RHC_Price "J0129 Injection, abatacept, 10 mg" RXC01745 CDM 636 RC J0129 HCPCS facility both 535 535 Gross Charge Type: NIHD_Clinic_Price J2212 Methylnaltrexone (Relistor) 12mg/0.6ml RXC01929 CDM 636 RC J2212 HCPCS facility both 204 204 Gross Charge Type: NIHD_RHC_Price J2212 Methylnaltrexone (Relistor) 12mg/0.6ml RXC01929 CDM 636 RC J2212 HCPCS facility both 204 204 Gross Charge Type: NIHD_Clinic_Price "J7510 Prednisolone oral, per 5 mg" RXC01964 CDM 636 RC J7510 HCPCS facility both 6 6 Gross Charge Type: NIHD_RHC_Price "J7510 Prednisolone oral, per 5 mg" RXC01964 CDM 636 RC J7510 HCPCS facility both 6 6 Gross Charge Type: NIHD_Clinic_Price DEPO-MEDROL 80 MG/UNIT RXC01966 CDM 636 RC J1010 HCPCS facility both 269 269 Gross Charge Type: NIHD_RHC_Price DEPO-MEDROL 80 MG/UNIT RXC01966 CDM 636 RC J1010 HCPCS facility both 269 269 Gross Charge Type: NIHD_Clinic_Price "J0561 Injection, penicillin g benzathine, 100,000 units" RXC02065 CDM 636 RC J0561 HCPCS facility both 30 30 Gross Charge Type: NIHD_RHC_Price "J0561 Injection, penicillin g benzathine, 100,000 units" RXC02065 CDM 636 RC J0561 HCPCS facility both 30 30 Gross Charge Type: NIHD_Clinic_Price "J7298 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg" RXC02130 CDM 636 RC J7298 HCPCS facility both 1212 1212 Gross Charge Type: NIHD_RHC_Price "J0131 Injection, acetaminophen, 10 mg" RXC02138 CDM 636 RC J0131 HCPCS facility both 4 4 Gross Charge Type: NIHD_RHC_Price "J0131 Injection, acetaminophen, 10 mg" RXC02138 CDM 636 RC J0131 HCPCS facility both 4 4 Gross Charge Type: NIHD_Clinic_Price "J2315 Injection, naltrexone, depot form, 1 mg" RXC02177 CDM 636 RC J2315 HCPCS facility both 1413 1413 Gross Charge Type: NIHD_RHC_Price "J2315 Injection, naltrexone, depot form, 1 mg" RXC02177 CDM 636 RC J2315 HCPCS facility both 1413 1413 Gross Charge Type: NIHD_Clinic_Price "J1335 Injection, ertapenem sodium, 1g" RXC02187 CDM 636 RC J1335 HCPCS facility both 417 417 Gross Charge Type: NIHD_RHC_Price "J1335 Injection, ertapenem sodium, 1g" RXC02187 CDM 636 RC J1335 HCPCS facility both 417 417 Gross Charge Type: NIHD_Clinic_Price J1726 Hydroxyprogesterone Caproate (Makena) RXC02196 CDM 636 RC J1726 HCPCS facility both 954 954 Gross Charge Type: NIHD_RHC_Price J1726 Hydroxyprogesterone Caproate (Makena) RXC02196 CDM 636 RC J1726 HCPCS facility both 954 954 Gross Charge Type: NIHD_Clinic_Price "J7620 Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, administered through dme" RXC04504 CDM 636 RC J7620 HCPCS facility both 42 42 Gross Charge Type: NIHD_RHC_Price "J7620 Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, administered through dme" RXC04504 CDM 636 RC J7620 HCPCS facility both 42 42 Gross Charge Type: NIHD_Clinic_Price "J7699 Racemisc Epi, inhalation solution administered" RXC04534 CDM 636 RC J7699 HCPCS facility both 12 12 Gross Charge Type: NIHD_Clinic_Price "Q0144 Azithromycin dihydrate, oral, capsules/powder, 1 gram" RXC04651 CDM 636 RC Q0144 HCPCS facility both 18 18 Gross Charge Type: NIHD_RHC_Price "Q0144 Azithromycin dihydrate, oral, capsules/powder, 1 gram" RXC04651 CDM 636 RC Q0144 HCPCS facility both 18 18 Gross Charge Type: NIHD_Clinic_Price "J2405 Injection, ondansetron hydrochloride, per 1 mg" RXC04736 CDM 636 RC J2405 HCPCS facility both 5 5 Gross Charge Type: NIHD_RHC_Price "J2405 Injection, ondansetron hydrochloride, per 1 mg" RXC04736 CDM 636 RC J2405 HCPCS facility both 6 6 Gross Charge Type: NIHD_Clinic_Price "J1885 Injection, ketorolac tromethamine, per 60mg" RXC04769 CDM 636 RC J1885 HCPCS facility both 12 12 Gross Charge Type: NIHD_RHC_Price "J1885 Injection, ketorolac tromethamine, per 60mg" RXC04769 CDM 636 RC J1885 HCPCS facility both 12 12 Gross Charge Type: NIHD_Clinic_Price "J1885 Injection, ketorolac tromethamine, per 30mg" RXC04777 CDM 636 RC J1885 HCPCS facility both 18 18 Gross Charge Type: NIHD_RHC_Price "J1885 Injection, ketorolac tromethamine, per 30mg" RXC04777 CDM 636 RC J1885 HCPCS facility both 18 18 Gross Charge Type: NIHD_Clinic_Price "J0696 Injection, ceftriaxone sodium 1gm" RXC04795 CDM 636 RC J0696 HCPCS facility both 138 138 Gross Charge Type: NIHD_RHC_Price "J0696 Injection, ceftriaxone sodium 1gm" RXC04795 CDM 636 RC J0696 HCPCS facility both 138 138 Gross Charge Type: NIHD_Clinic_Price "J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg" RXC04827 CDM 636 RC J3301 HCPCS facility both 36 36 Gross Charge Type: NIHD_RHC_Price "J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg" RXC04827 CDM 636 RC J3301 HCPCS facility both 36 36 Gross Charge Type: NIHD_Clinic_Price "J1100 Injection, dexamethasone sodium phosphate, 1mg" RXC04885 CDM 636 RC J1100 HCPCS facility both 6 6 Gross Charge Type: NIHD_RHC_Price "J1100 Injection, dexamethasone sodium phosphate, 1mg" RXC04885 CDM 636 RC J1100 HCPCS facility both 7 7 Gross Charge Type: NIHD_Clinic_Price "J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg" RXC04915 CDM 636 RC J0702 HCPCS facility both 44 44 Gross Charge Type: NIHD_RHC_Price "J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg" RXC04915 CDM 636 RC J0702 HCPCS facility both 41 41 Gross Charge Type: NIHD_Clinic_Price "J0696 Injection, ceftriaxone sodium, 1000mg" RXC05505 CDM 636 RC J0696 HCPCS facility both 274 274 Gross Charge Type: NIHD_RHC_Price "J0696 Injection, ceftriaxone sodium, 1000mg" RXC05505 CDM 636 RC J0696 HCPCS facility both 274 274 Gross Charge Type: NIHD_Clinic_Price "J1050 Injection, medroxyprogesterone acetate, 1 mg" RXC05545 CDM 636 RC J1050 HCPCS facility both 1.72 1.72 Gross Charge Type: NIHD_RHC_Price "J1050 Injection, medroxyprogesterone acetate, 1 mg" RXC05545 CDM 636 RC J1050 HCPCS facility both 1.72 1.72 Gross Charge Type: NIHD_Clinic_Price DEPO-MEDROL 40MG/UNIT RXC05678 CDM 636 RC J1010 HCPCS facility both 27 27 Gross Charge Type: NIHD_RHC_Price J1670 Tetanus Immune Globulin 250 U RXC05960 CDM 636 RC J1670 HCPCS facility both 673 673 Gross Charge Type: NIHD_RHC_Price J1670 Tetanus Immune Globulin 250 U RXC05960 CDM 636 RC J1670 HCPCS facility both 673 673 Gross Charge Type: NIHD_Clinic_Price "J2550 Injection, promethazine hcl, up to 50 mg" RXC06422 CDM 636 RC J2550 HCPCS facility both 156 156 Gross Charge Type: NIHD_RHC_Price "J2550 Injection, promethazine hcl, up to 50 mg" RXC06422 CDM 636 RC J2550 HCPCS facility both 157 157 Gross Charge Type: NIHD_Clinic_Price "J2919 Injection, methylprednisolone sodium succina" RXC06631 CDM 636 RC J2919 HCPCS facility both 17 17 Gross Charge Type: NIHD_RHC_Price J3490 bupivacaine 0.5% 30 ML Vial RXC08007 CDM 636 RC J3490 HCPCS facility both 142 142 Gross Charge Type: NIHD_RHC_Price J3490 bupivacaine 0.5% 30 ML Vial RXC08007 CDM 636 RC J3490 HCPCS facility both 149 149 Gross Charge Type: NIHD_Clinic_Price "J3145 Inject,Aveed testosterone undecanoate 1mg" RXC1001 CDM 636 RC J3145 HCPCS facility both 3.17 3.17 Gross Charge Type: NIHD_RHC_Price "J3145 Inject,Aveed testosterone undecanoate 1mg" RXC1001 CDM 636 RC J3145 HCPCS facility both 3.17 3.17 Gross Charge Type: NIHD_Clinic_Price "J7613 Albuterol, inhalation solution, non-compounded, administered through dme, unit dose, 1 mg" RXC10610 CDM 636 RC J7613 HCPCS facility both 7 7 Gross Charge Type: NIHD_RHC_Price "J7613 Albuterol, inhalation solution, non-compounded, administered through dme, unit dose, 1 mg" RXC10610 CDM 636 RC J7613 HCPCS facility both 7 7 Gross Charge Type: NIHD_Clinic_Price "J1071 Injection, testosterone cypionate 1mg" RXC1071 CDM 636 RC J1071 HCPCS facility both 36 36 Gross Charge Type: NIHD_RHC_Price "J1071 Injection, testosterone cypionate 1mg" RXC1071 CDM 636 RC J1071 HCPCS facility both 37 37 Gross Charge Type: NIHD_Clinic_Price "J8540 Dexamethasone, oral, 0.25 mg" RXC10773 CDM 636 RC J8540 HCPCS facility both 11 11 Gross Charge Type: NIHD_RHC_Price "J8540 Dexamethasone, oral, 0.25 mg" RXC10773 CDM 636 RC J8540 HCPCS facility both 12 12 Gross Charge Type: NIHD_Clinic_Price "J3030 Injection, sumatriptan succinate, 6 mg" RXC10867 CDM 636 RC J3030 HCPCS facility both 180 180 Gross Charge Type: NIHD_RHC_Price "J0171 Injection, adrenalin, epinephrine" RXC11102 CDM 636 RC J0171 HCPCS facility both 7 7 Gross Charge Type: NIHD_RHC_Price "J0171 Injection, adrenalin, epinephrine" RXC11102 CDM 636 RC J0171 HCPCS facility both 8 8 Gross Charge Type: NIHD_Clinic_Price "J3420 Injection, vitamin b-12, up to 1000mcg" RXC11118 CDM 636 RC J3420 HCPCS facility both 8 8 Gross Charge Type: NIHD_RHC_Price "J3420 Injection, vitamin b-12, up to 1000mcg" RXC11118 CDM 636 RC J3420 HCPCS facility both 9 9 Gross Charge Type: NIHD_Clinic_Price "J1885 Injection, ketorolac tromethamine, per 15 mg" RXC11918 CDM 636 RC J1885 HCPCS facility both 14 14 Gross Charge Type: NIHD_RHC_Price "J1885 Injection, ketorolac tromethamine, per 15 mg" RXC11918 CDM 636 RC J1885 HCPCS facility both 14 14 Gross Charge Type: NIHD_Clinic_Price J7296 Levonorgestrel Release Intrauterine Contraceptive System (Kyleena) RXC12424 CDM 636 RC J7296 HCPCS facility both 1635 1635 Gross Charge Type: NIHD_RHC_Price J7296 Levonorgestrel Release Intrauterine Contraceptive System (Kyleena) RXC12424 CDM 636 RC J7296 HCPCS facility both 1636 1636 Gross Charge Type: NIHD_Clinic_Price "J7307 Etonogestrel (contraceptive) implant system, including implant and supplies NIHD" RXC12441 CDM 636 RC J7307 HCPCS facility both 1259 1259 Gross Charge Type: NIHD_RHC_Price "J7307 Etonogestrel (contraceptive) implant system, including implant and supplies NIHD" RXC12441 CDM 636 RC J7307 HCPCS facility both 1258 1258 Gross Charge Type: NIHD_Clinic_Price "90375 Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use" RXC12478 CDM 636 RC 90375 HCPCS facility both 1518 1518 Gross Charge Type: NIHD_RHC_Price "90375 Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use" RXC12478 CDM 636 RC 90375 HCPCS facility both 1518 1518 Gross Charge Type: NIHD_Clinic_Price J7300 Intrauterine copper contraceptive RXC1856 CDM 636 RC J7300 HCPCS facility both 1251 1251 Gross Charge Type: NIHD_RHC_Price J7300 Intrauterine copper contraceptive RXC1856 CDM 636 RC J7300 HCPCS facility both 1251 1251 Gross Charge Type: NIHD_Clinic_Price SOLU-MEDROL 40 MG/UNIT RXC1881 CDM 636 RC J2920 HCPCS facility both 12 12 Gross Charge Type: NIHD_RHC_Price "90378 Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg" RXC90378 CDM 636 RC 90378 HCPCS facility both 1851 1851 Gross Charge Type: NIHD_RHC_Price "90378 Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg" RXC90378 CDM 636 RC 90378 HCPCS facility both 1940 1940 Gross Charge Type: NIHD_Clinic_Price "J0696 Injection, ceftriaxone sodium, per 250 mg" RXC92047 CDM 636 RC J0696 HCPCS facility both 36 36 Gross Charge Type: NIHD_RHC_Price "J0696 Injection, ceftriaxone sodium, per 250 mg" RXC92047 CDM 636 RC J0696 HCPCS facility both 36 36 Gross Charge Type: NIHD_Clinic_Price amoxicillin 400 mg/5 mL 100mL Oral Liq [INYO] RXP01230 CDM 00093-4161-73 NDC facility both 100 ML 58.86 58.86 Gross Charge Type: Pharmacy amoxicillin 400 mg/5 mL 100mL Oral Liq [INYO] RXP01230 CDM 00781-6157-46 NDC facility both 100 ML 58.86 58.86 Gross Charge Type: Pharmacy arsenic trioxide 1 mg/mL IV Sol [INYO] RXP01237 CDM J9017 HCPCS 63459-0600-10 NDC facility both 10 ML 2159 2159 Gross Charge Type: Pharmacy loratadine 5 mg/5 mL Oral Syrup [INYO] RXP01293 CDM 51672-2092-08 NDC facility both 120 ML 59.7 59.7 Gross Charge Type: Pharmacy loratadine 5 mg/5 mL Oral Syrup [INYO] RXP01293 CDM 51672-2131-08 NDC facility both 120 ML 59.34 59.34 Gross Charge Type: Pharmacy trypan blue Ophth 0.06% Sol [INYO] RXP01500 CDM 68803-0612-10 NDC facility both 1 EA 320 320 Gross Charge Type: Pharmacy | NDC EA = 0.5 APP ezetimibe 10 mg Tab [INYO] RXP01502 CDM 50268-0298-12 NDC facility both 1 EA 61.96 61.96 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ezetimibe 10 mg Tab [INYO] RXP01502 CDM 67877-0490-90 NDC facility both 1 EA 51.41 51.41 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acyclovir 500 mg/10 mL IV Sol [INYO] RXP01504 CDM J0133 HCPCS 55150-0154-10 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy acyclovir 500 mg/10 mL IV Sol [INYO] RXP01504 CDM J0133 HCPCS 63323-0325-10 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy linezolid 600 mg Tab [INYO] RXP01507 CDM 00904-6553-04 NDC facility both 1 EA 732 732 Gross Charge Type: Pharmacy | NDC EA = 1 TAB linezolid 600 mg Tab [INYO] RXP01507 CDM 00009-5135-02 NDC facility both 1 EA 748.92 748.92 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2.5 units-18.5 mcg/0.5 mL IM Susp 0 mL [INYO]" RXP01509 CDM 58160-0842-11 NDC facility both 0.5 ML 406.64 406.64 Gross Charge Type: Pharmacy "tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2.5 units-18.5 mcg/0.5 mL IM Susp 0 mL [INYO]" RXP01509 CDM 58160-0842-52 NDC facility both 0.5 ML 414.58 414.58 Gross Charge Type: Pharmacy morphine 15 mg Tab [INYO] RXP01510 CDM 00054-0235-24 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Percocet 5/325 mg #6 oral Tab [INYO] RXP01511 CDM 00406-0512-62-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE-acetaminophen - Tab RXP01511 CDM 68071-2932-06 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Augmentin 875 mg #3 oral Tab [INYO] RXP01512 CDM 68071-5065-03 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amoxicillin-clavulanate - Tab RXP01512 CDM 68071-4549-03 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Augmentin 875 mg #3 oral Tab [INYO] RXP01512 CDM 66685-1001-00-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Augmentin 875 mg #3 oral Tab [INYO] RXP01512 CDM 68071-2502-03 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB morphine 20 mg/mL Oral Conc [INYO] RXP01513 CDM 68094-0755-58 NDC facility both 1 ML 35 35 Gross Charge Type: Pharmacy morphine 20 mg/mL ORAL SYR Con UD [INYO] RXP01513 CDM 68094-0754-58 NDC facility both 1 ML 35 35 Gross Charge Type: Pharmacy carbamide peroxide Otic 6.5% Sol [INYO] RXP01515 CDM 00904-6627-35 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS carbamide peroxide Otic 6.5% Sol [INYO] RXP01515 CDM 42037-0104-78 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS rosuvastatin 10 mg Tab [INYO] RXP01520 CDM 60687-0245-65 NDC facility both 1 EA 8.25 8.25 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rosuvastatin 10 mg Tab [INYO] RXP01520 CDM 00904-6779-61 NDC facility both 1 EA 9.88 9.88 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rosuvastatin 10 mg Tab [INYO] RXP01520 CDM 50268-0709-15 NDC facility both 1 EA 8.24 8.24 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rosuvastatin 10 mg Tab [INYO] RXP01520 CDM 00904-6603-61 NDC facility both 1 EA 8.62 8.62 Gross Charge Type: Pharmacy | NDC EA = 1 TAB meloxicam 15 mg Tab [INYO] RXP01521 CDM 50268-0526-15 NDC facility both 1 EA 27.98 27.98 Gross Charge Type: Pharmacy | NDC EA = 1 TAB meloxicam 15 mg Tab [INYO] RXP01521 CDM 60687-0199-01 NDC facility both 1 EA 28.68 28.68 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buPROPion 100 mg/12 hours Tab [INYO] RXP01523 CDM 70436-0058-01 NDC facility both 1 EA 10.13 10.13 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buPROPion 100 mg SR Tab [INYO] RXP01523 CDM 68084-0697-01 NDC facility both 1 EA 9.98 9.98 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buPROPion 100 mg SR Tab [INYO] RXP01523 CDM 51079-0391-20 NDC facility both 1 EA 10.13 10.13 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buPROPion 150 mg/24 hours ER Tab [INYO] RXP01524 CDM 50268-0140-13 NDC facility both 1 EA 46.58 46.58 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buPROPion 150 mg/24 hours Tab RXP01524 CDM 00904-7084-04 NDC facility both 1 EA 9.48 9.48 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buPROPion 150 mg/24 hours ER Tab [INYO] RXP01524 CDM 69097-0875-02 NDC facility both 1 EA 28.64 28.64 Gross Charge Type: Pharmacy | NDC EA = 1 TAB OXcarbazepine 150 mg Tab [INYO] RXP01529 CDM 50268-0679-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxcarbazepine 150 mg Tab [INYO] RXP01529 CDM 68084-0845-01 NDC facility both 1 EA 9.05 9.05 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxcarbazepine 150 mg Tab [INYO] RXP01529 CDM 51991-0292-01 NDC facility both 1 EA 8.62 8.62 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxcarbazepine 150 mg Tab [INYO] RXP01529 CDM 00054-0097-20 NDC facility both 1 EA 9.16 9.16 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cyanocobalamin 500 mcg Tab [INYO] RXP01533 CDM 77333-0937-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sevelamer carbonate 800 mg Tab UD [INYO] RXP01535 CDM 00904-6707-06 NDC facility both 1 EA 20.76 20.76 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sevelamer carbonate 800 mg Tab UD [INYO] RXP01535 CDM 60687-0328-31 NDC facility both 1 EA 59.49 59.49 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dutasteride 0.5 mg Cap [INYO] RXP01543 CDM 31722-0131-30 NDC facility both 1 EA 36.3 36.3 Gross Charge Type: Pharmacy | NDC EA = 1 CAP dutasteride 0.5 mg Cap [INYO] RXP01543 CDM 00173-0712-15 NDC facility both 1 EA 47.55 47.55 Gross Charge Type: Pharmacy | NDC EA = 1 CAP bimatoprost 0.03% Ophth Sol [INYO] RXP01544 CDM 68180-0429-02 NDC facility both 1 EA 1076.56 1076.56 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS megestrol 40 mg/mL Oral Susp [INYO] RXP01547 CDM 00121-4776-10 NDC facility both 10 ML 27.15 27.15 Gross Charge Type: Pharmacy megestrol 40 mg/mL Oral Susp [INYO] RXP01547 CDM 66689-0020-01 NDC facility both 10 ML 25.5 25.5 Gross Charge Type: Pharmacy chlorhexidine Top 4% Soap [INYO] RXP01548 CDM 00234-0575-04 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 118 APP lidocaine Top 5% film [INYO] RXP01549 CDM 00591-3525-30 NDC facility both 1 EA 46.8 46.8 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES lidocaine topical 5% Fil [inyo] RXP01549 CDM 00378-9055-93 NDC facility both 1 EA 51.38 51.38 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES lidocaine topical 5% Film [INYO] RXP01549 CDM 65162-0791-08 NDC facility both 1 EA 51.38 51.38 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES "leuprolide 3.75 mg/month IM Inj, ER [INYO]" RXP01552 CDM J1950 HCPCS 00074-3641-03 NDC facility both 1 EA 8379.6 8379.6 Gross Charge Type: Pharmacy PAClitaxel protein-bound 100 mg IV Inj [INYO] RXP01554 CDM J9264 HCPCS 68817-0134-50 NDC facility both 1 EA 8681.46 8681.46 Gross Charge Type: Pharmacy iron dextran 50 mg/mL Inj Sol [INYO] RXP01555 CDM J1750 HCPCS 00023-6082-10 NDC facility both 2 ML 330 330 Gross Charge Type: Pharmacy iron dextran 50 mg/mL Inj Sol [INYO] RXP01555 CDM J1750 HCPCS 52544-0931-02 NDC facility both 2 ML 330 330 Gross Charge Type: Pharmacy saccharomyces boulardii lyo 250 mg oral Pwdr for recon [INYO] RXP01559 CDM 04142-0000-40 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP sodium bicarbonate 325 mg Tab [INYO] RXP01560 CDM 00223-1720-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB iron sucrose 100 mg/5 mL IV Sol [INYO] RXP01562 CDM J1756 HCPCS 00517-2340-25 NDC facility both 5 ML 587.71 587.71 Gross Charge Type: Pharmacy Dextrose 5% in Water with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP01576 CDM J3480 HCPCS 63323-0669-10 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP01576 CDM J3480 HCPCS 00409-7905-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP01576 CDM J3480 HCPCS 00264-7625-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP01576 CDM J3480 HCPCS 00990-7905-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Water with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP01576 CDM J3480 HCPCS 00338-0683-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy hydrochlorothiazide 12.5 mg Cap [INYO] RXP01579 CDM 50228-0146-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP hydroCHLOROthiazide 12.5 mg Cap RXP01579 CDM 50268-0404-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP hydrochlorothiazide 12.5 mg Cap [INYO] RXP01579 CDM 51079-0776-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP divalproex sodium 125 mg Tab [INYO] RXP01581 CDM 60687-0211-21 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB divalproex sodium 125 mg Tab [INYO] RXP01581 CDM 62756-0796-88 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB divalproex sodium 500 mg ER Tab [INYO] RXP01583 CDM 68084-0415-02 NDC facility both 1 EA 18.16 18.16 Gross Charge Type: Pharmacy | NDC EA = 1 TAB divalproex sodium 500 mg ER Tab [INYO] RXP01583 CDM 00904-6364-45 NDC facility both 1 EA 22.19 22.19 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rifaximin 200 mg Tab [INYO] RXP01584 CDM 65649-0301-03 NDC facility both 1 EA 134.07 134.07 Gross Charge Type: Pharmacy | NDC EA = 1 TAB APAP-hydrocodone 108 mg-2.5 mg/5 mL UD [INYO] RXP01588 CDM 00121-4772-05 NDC facility both 5 ML 44.05 44.05 Gross Charge Type: Pharmacy "nystatin Top 100,000 units/g Pwdr [INYO]" RXP01592 CDM 00832-0465-15 NDC facility both 1 EA 187.3 187.3 Gross Charge Type: Pharmacy | NDC EA = 15 APP "nystatin Top 100,000 units/g Pwdr [INYO]" RXP01592 CDM 39822-3015-01 NDC facility both 1 EA 93.75 93.75 Gross Charge Type: Pharmacy | NDC EA = 15 APP aspirin-dipyridamole 25 mg-200 mg ERCap [INYO] RXP01595 CDM 00597-0001-60 NDC facility both 1 EA 56.39 56.39 Gross Charge Type: Pharmacy | NDC EA = 1 CAP APAP/ASA/caffeine 250 mg-250 mg-65 mg Tab [INYO] RXP01596 CDM 70000-0146-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB APAP/ASA/caffeine 250 mg-250 mg-65 mg Tab [INYO] RXP01596 CDM 00904-5135-59 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB aMILoride 5 mg Tab [INYO] RXP01599 CDM 50268-0071-15 NDC facility both 1 EA 7.49 7.49 Gross Charge Type: Pharmacy | NDC EA = 1 TAB alendronate 70 mg Tab [INYO] RXP01600 CDM 69097-0224-16 NDC facility both 1 EA 102.44 102.44 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acarbose 100 mg Tab [INYO] RXP01603 CDM 47781-0342-01 NDC facility both 1 EA 6.96 6.96 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acamprosate 333 mg Tab RXP01604 CDM 60687-0121-25 NDC facility both 1 EA 16.27 16.27 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acamprosate 333 mg Oral EC Tab [INYO] RXP01604 CDM 68462-0435-18 NDC facility both 1 EA 10.54 10.54 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acarbose 25 mg Tab [INYO] RXP01605 CDM 00054-0140-25 NDC facility both 1 ML 6 6 Gross Charge Type: Pharmacy acarbose 25 mg Tab [INYO] RXP01605 CDM 47781-0340-01 NDC facility both 1 ML 6 6 Gross Charge Type: Pharmacy ammonium lactate Top 12% Lotion [INYO] RXP01607 CDM 45802-0525-55 NDC facility both 1 EA 91.2 91.2 Gross Charge Type: Pharmacy | NDC EA = 225 APP alprostadil 500mcg/mL Inj Sol [INYO] RXP01608 CDM J0270 HCPCS 00009-3169-06 NDC facility both 1 ML 1520 1520 Gross Charge Type: Pharmacy "heparin 1,000 UNIT/500 ML-NS [INYO]" RXP01609 CDM J1642 HCPCS 00264-9872-10 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy carBAMazepine 100 mg Chew Tab [INYO] RXP01613 CDM 00093-0778-01 NDC facility both 1 EA 1 1 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carBAMazepine 100 mg Chew Tab [INYO] RXP01613 CDM 00904-3854-61 NDC facility both 1 EA 1 1 Gross Charge Type: Pharmacy | NDC EA = 1 TAB candesartan 16 mg Tab [INYO] RXP01614 CDM 00186-0016-31 NDC facility both 1 EA 21.15 21.15 Gross Charge Type: Pharmacy | NDC EA = 1 TAB candesartan 4 mg Tab [INYO] RXP01615 CDM 00186-0004-31 NDC facility both 1 EA 25.57 25.57 Gross Charge Type: Pharmacy | NDC EA = 1 TAB calcium-vitamin D 315 mg-250 intl units Tab [INYO] RXP01617 CDM 77333-0113-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cyclophosphamide 50 mg Cap [INYO] RXP01621 CDM J8530 HCPCS 00054-0383-25 NDC facility both 1 EA 85.91 85.91 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ciprofloxacin-dexamethasone 0.3%-0.1% Otic Susp [INYO] RXP01628 CDM 43598-0326-75 NDC facility both 1 EA 1076.08 1076.08 Gross Charge Type: Pharmacy | NDC EA = 7.5 DROPS ciprofloxacin-dexamethasone 0.3%-0.1% Otic Susp [INYO] RXP01628 CDM 00065-8533-02 NDC facility both 1 EA 1133.28 1133.28 Gross Charge Type: Pharmacy | NDC EA = 7.5 DROPS ciprofloxacin-dexamethasone otic 0.3%-0.1% Sus [inyo] RXP01628 CDM 62756-0427-90 NDC facility both 1 EA 1120.92 1120.92 Gross Charge Type: Pharmacy | NDC EA = 7.5 DROPS ciprofloxacin-dexamethasone 0.3%-0.1% Otic Susp [INYO] RXP01628 CDM 00781-6186-67 NDC facility both 1 EA 1120.92 1120.92 Gross Charge Type: Pharmacy | NDC EA = 7.5 DROPS brimonidine Ophth 0.15% Sol [INYO] RXP01636 CDM 00023-9177-10 NDC facility both 1 EA 1718.6 1718.6 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS benzocaine topical 20% Gel(INYO) RXP01638 CDM 10310-0283-13 NDC facility both 1 EA 29.6 29.6 Gross Charge Type: Pharmacy | NDC EA = 11.9 APP azaTHIOprine 50 mg Tab [INYO] RXP01639 CDM J7500 HCPCS 68084-0229-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB azaTHIOprine 50 mg Tab [INYO] RXP01639 CDM J7500 HCPCS 51079-0620-06 NDC facility both 1 EA 14.07 14.07 Gross Charge Type: Pharmacy | NDC EA = 1 TAB DULoxetine 30 mg Cap [INYO] RXP01659 CDM 00904-6453-61 NDC facility both 1 EA 35.55 35.55 Gross Charge Type: Pharmacy | NDC EA = 1 CAP DULoxetine 30 mg Cap [INYO] RXP01659 CDM 00904-7044-61 NDC facility both 1 EA 10.34 10.34 Gross Charge Type: Pharmacy | NDC EA = 1 CAP diclofenac sodium 50 mg Oral EC Tab [INYO] RXP01667 CDM 51079-0466-20 NDC facility both 1 EA 8.83 8.83 Gross Charge Type: Pharmacy | NDC EA = 1 TAB desmopressin 10 mcg/inh Nasal Spry [INYO] RXP01671 CDM 60505-0815-00 NDC facility both 1 EA 985 985 Gross Charge Type: Pharmacy | NDC EA = 5 SPRAYS desmopressin 10 mcg/inh Nasal Spry [INYO] RXP01671 CDM 24208-0342-05 NDC facility both 1 EA 985.04 985.04 Gross Charge Type: Pharmacy | NDC EA = 5 SPRAYS fluPHENAZine 5 mg Tab [INYO] RXP01674 CDM 51079-0487-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB fenofibrate 48 mg Tab [INYO] RXP01678 CDM 69097-0459-05 NDC facility both 1 EA 11.46 11.46 Gross Charge Type: Pharmacy | NDC EA = 1 TAB fenofibrate 48 mg Tab [INYO] RXP01678 CDM 60687-0618-21 NDC facility both 1 EA 11.46 11.46 Gross Charge Type: Pharmacy | NDC EA = 1 TAB fenofibrate 48 mg Tab [INYO] RXP01678 CDM 68084-0635-21 NDC facility both 1 EA 11.46 11.46 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lisinopril 20 mg Tab [INYO] RXP01683 CDM 60687-0333-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lisinopril 20 mg Tab [INYO] RXP01683 CDM 00904-6486-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lisinopril 20 mg Tab [INYO] RXP01683 CDM 00904-6799-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB atorvastatin 10 mg Tab [INYO] RXP01684 CDM 00904-6290-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrocortisone 10 mg Tab [INYO] RXP01695 CDM 50268-0406-15 NDC facility both 1 EA 12.14 12.14 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrocortisone 10 mg Tab [INYO] RXP01695 CDM 59762-0074-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrALAZINE 10 mg Tab [INYO] RXP01696 CDM 00904-6440-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrALAZINE 10 mg Tab [inyo] RXP01696 CDM 68084-0447-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrALAZINE 10 mg Tab [INYO] RXP01696 CDM 51079-0074-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hetastarch 60 mg/mL-NS IV Sol [INYO] RXP01697 CDM 00264-1965-10 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy magnesium hydroxide 8% Oral Susp 480 mL [INYO] RXP01700 CDM 11845-0124-13 NDC facility both 480 ML 15 15 Gross Charge Type: Pharmacy gabapentin 400 mg Cap [INYO] RXP01703 CDM 00904-6667-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP benazepril 20 mg Tab [INYO] RXP01718 CDM 50268-0111-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB benazepril 20 mg Tab [INYO] RXP01718 CDM 51079-0146-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levofloxacin 750 mg/150 mL IV Sol [INYO] RXP01719 CDM J1956 HCPCS 00409-0528-35 NDC facility both 150 ML 265 265 Gross Charge Type: Pharmacy levoFLOXacin 750 mg/150 mL Sol RXP01719 CDM J1956 HCPCS 00409-4444-24 NDC facility both 150 ML 265 265 Gross Charge Type: Pharmacy levofloxacin 750 mg/150 mL IV Sol [INYO] RXP01719 CDM J1956 HCPCS 00781-3343-09 NDC facility both 150 ML 265 265 Gross Charge Type: Pharmacy levofloxacin 750 mg/150 mL IV Sol [INYO] RXP01719 CDM J1956 HCPCS 36000-0048-24 NDC facility both 150 ML 265 265 Gross Charge Type: Pharmacy mesalamine 400 mg Cap [INYO] RXP01725 CDM 60687-0556-32 NDC facility both 1 EA 36.72 36.72 Gross Charge Type: Pharmacy mesalamine 400 mg Cap [INYO] RXP01725 CDM 59762-0117-01 NDC facility both 1 EA 25.14 25.14 Gross Charge Type: Pharmacy ROPivacaine 0.5% Sol [INYO] RXP01726 CDM J2795 HCPCS 70069-0064-10 NDC facility both 30 ML 235 235 Gross Charge Type: Pharmacy ropivacaine 0.5% Inj Sol 30 mL [INYO] RXP01726 CDM J2795 HCPCS 63323-0286-35 NDC facility both 30 ML 270.91 270.91 Gross Charge Type: Pharmacy ropivacaine 0.5% Inj Sol 30 mL [INYO] RXP01726 CDM J2795 HCPCS 00409-9301-30 NDC facility both 30 ML 235 235 Gross Charge Type: Pharmacy moxifloxacin 0.5% Ophth Sol [INYO] RXP01727 CDM 60505-0582-04 NDC facility both 1 EA 669.4 669.4 Gross Charge Type: Pharmacy | NDC EA = 3 DROPS moxifloxacin ophthalmic 0.5% Sol [inyo] RXP01727 CDM 68180-0422-01 NDC facility both 1 EA 669.4 669.4 Gross Charge Type: Pharmacy | NDC EA = 3 DROPS moxifloxacin 0.5% Ophth Sol [INYO] RXP01727 CDM 00065-4013-03 NDC facility both 1 EA 835.76 835.76 Gross Charge Type: Pharmacy | NDC EA = 3 DROPS levothyroxine 75 mcg (0.075 mg) Tab [INYO] RXP01731 CDM 00904-6951-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 75 mcg (0.075 mg) Tab [INYO] RXP01731 CDM 00074-5182-11 NDC facility both 1 EA 9.35 9.35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB simvastatin 10 mg Tab [INYO] RXP01733 CDM 63739-0571-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB simvastatin 10 mg Tab [INYO] RXP01733 CDM 68084-0511-01 NDC facility both 1 EA 16.73 16.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB simvastatin 10 mg Tab [INYO] RXP01733 CDM 51079-0454-20 NDC facility both 1 EA 16.73 16.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tiotropium 18 mcg Inh Cap [INYO] RXP01742 CDM 00597-0075-75 NDC facility both 1 EA 129.83 129.83 Gross Charge Type: Pharmacy thalidomide 100 mg Oral Cap [INYO] RXP01743 CDM 59572-0210-15 NDC facility both 1 EA 1331.56 1331.56 Gross Charge Type: Pharmacy | NDC EA = 1 CAP abatacept 250 mg IV Inj [INYO] RXP01745 CDM J0129 HCPCS 00003-2187-13 NDC facility both 1 EA 5896.64 5896.64 Gross Charge Type: Pharmacy abatacept 250 mg IV Inj [INYO] RXP01745 CDM J0129 HCPCS 00003-2187-10 NDC facility both 1 EA 5642.74 5642.74 Gross Charge Type: Pharmacy linezolid 600 mg/300 mL-D5% Sol [INYO] RXP01746 CDM J2020 HCPCS 57664-0683-57 NDC facility both 300 ML 625.03 625.03 Gross Charge Type: Pharmacy linezolid 600 mg/300 mL-D5% Sol [INYO] RXP01746 CDM J2020 HCPCS 55150-0242-51 NDC facility both 300 ML 880.01 880.01 Gross Charge Type: Pharmacy memantine 10 mg Tab [INYO] RXP01747 CDM 00904-6506-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB valACYclovir 500 mg Tab [INYO] RXP01761 CDM 00904-6565-07 NDC facility both 1 EA 23.82 23.82 Gross Charge Type: Pharmacy | NDC EA = 1 TAB torsemide 20 mg Tab [INYO] RXP01766 CDM 00904-7283-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB torsemide 20 mg Tab [INYO] RXP01766 CDM 50268-0756-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB torsemide 20 mg Tab [INYO] RXP01766 CDM 50111-0917-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tiZANidine 4 mg Tab [INYO] RXP01768 CDM 00904-6418-61 NDC facility both 1 EA 10.58 10.58 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dorzolamide-timolol Ophth 2%-0.5% Sol [INYO] RXP01769 CDM 24208-0486-10 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS timolol 10 mg Tab [INYO] RXP01770 CDM 00378-0221-01 NDC facility both 1 EA 10.22 10.22 Gross Charge Type: Pharmacy | NDC EA = 1 TAB theophylline 300 mg ER Tab [INYO] RXP01774 CDM 62332-0025-31 NDC facility both 1 EA 25.77 25.77 Gross Charge Type: Pharmacy | NDC EA = 1 TAB theophylline 300 mg ER Tab [INYO] RXP01774 CDM 00904-5889-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB telmisartan 80 mg Tab [INYO] RXP01779 CDM 68462-0201-13 NDC facility both 1 EA 33.09 33.09 Gross Charge Type: Pharmacy | NDC EA = 1 TAB telmisartan 80 mg Tab [INYO] RXP01779 CDM 00378-2922-93 NDC facility both 1 EA 33.13 33.13 Gross Charge Type: Pharmacy | NDC EA = 1 TAB telmisartan 80 mg Tab [INYO] RXP01779 CDM 00781-5378-64 NDC facility both 1 EA 26.04 26.04 Gross Charge Type: Pharmacy | NDC EA = 1 TAB telmisartan 80 mg Tab [INYO] RXP01779 CDM 00597-0041-37 NDC facility both 1 EA 51.78 51.78 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tacrolimus 1 mg Cap [INYO] RXP01781 CDM J7507 HCPCS 00469-0617-11 NDC facility both 1 EA 39.45 39.45 Gross Charge Type: Pharmacy | NDC EA = 1 CAP SUMAtriptan 100 mg Tab [INYO] RXP01782 CDM 63304-0099-19 NDC facility both 1 EA 125.7 125.7 Gross Charge Type: Pharmacy | NDC EA = 1 TAB SUMAtriptan 50 mg Tab [INYO] RXP01783 CDM 65862-0147-36 NDC facility both 1 EA 125.7 125.7 Gross Charge Type: Pharmacy | NDC EA = 1 TAB SUMAtriptan 50 mg Tab [INYO] RXP01783 CDM 63304-0098-19 NDC facility both 1 EA 125.7 125.7 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sodium chloride 1 g Tab [INYO] RXP01786 CDM 77333-0844-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sodium chloride 1 g Tab [INYO] RXP01786 CDM 00223-1760-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sodium chloride 1 g Tab [INYO] RXP01786 CDM 77333-0835-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB senna 8.6 mg Tab [INYO] RXP01790 CDM 00904-7252-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB senna 8.6 mg Tab [INYO] RXP01790 CDM 00904-6522-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB senna 8.6 mg Tab [INYO] RXP01790 CDM 49483-0080-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB senna 8.6 mg Tab [INYO] RXP01790 CDM 70000-0447-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB senna 8.6 mg Tab [INYO] RXP01790 CDM 00904-6725-59 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB risperiDONE 1 mg/mL Oral Sol [INYO] RXP01795 CDM 50458-0305-03 NDC facility both 30 ML 1833.56 1833.56 Gross Charge Type: Pharmacy rifampin 150 mg Cap [INYO] RXP01797 CDM 00185-0801-30 NDC facility both 1 EA 19.45 19.45 Gross Charge Type: Pharmacy | NDC EA = 1 CAP rifampin 150 mg Cap [INYO] RXP01797 CDM 68180-0658-06 NDC facility both 1 EA 19.45 19.45 Gross Charge Type: Pharmacy | NDC EA = 1 CAP repaglinide 0.5 mg Tab [INYO] RXP01799 CDM 00169-0081-81 NDC facility both 1 EA 40.95 40.95 Gross Charge Type: Pharmacy | NDC EA = 1 TAB raloxifene 60 mg Tab [INYO] RXP01802 CDM 00002-4165-02 NDC facility both 1 EA 36.04 36.04 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pyridostigmine 60 mg Tab [INYO] RXP01803 CDM 68084-0494-01 NDC facility both 1 EA 8.89 8.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pyridostigmine 60 mg Tab [INYO] RXP01803 CDM 63739-0969-40 NDC facility both 1 EA 8.92 8.92 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pyridostigmine 180 mg ER Tab [INYO] RXP01804 CDM 00187-3013-30 NDC facility both 1 EA 184.19 184.19 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pyrazinamide 500 mg Tab [INYO] RXP01805 CDM 61748-0012-06 NDC facility both 1 EA 37.89 37.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pyrazinamide 500 mg Tab [INYO] RXP01805 CDM 60687-0138-01 NDC facility both 1 EA 30.6 30.6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB propranolol 80 mg ER Cap [INYO] RXP01809 CDM 60687-0226-01 NDC facility both 1 EA 14.7 14.7 Gross Charge Type: Pharmacy | NDC EA = 1 CAP propafenone 225 mg Cap UD [INYO] RXP01810 CDM 60687-0185-32 NDC facility both 1 EA 49.71 49.71 Gross Charge Type: Pharmacy | NDC EA = 1 CAP progesterone 100 mg Cap [INYO] RXP01811 CDM 59651-0152-01 NDC facility both 1 EA 12.6 12.6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP progesterone 100 mg Cap [INYO] RXP01811 CDM 00032-1708-01 NDC facility both 1 EA 21.21 21.21 Gross Charge Type: Pharmacy | NDC EA = 1 CAP primidone 50 mg Tab [INYO] RXP01812 CDM 50268-0686-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB primidone 50 mg Tab [INYO] RXP01812 CDM 68084-0202-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pregabalin 50 mg oral capsule [INYO] RXP01813 CDM 00904-6992-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP pravastatin 40 mg Tab [INYO] RXP01815 CDM 00003-5194-10 NDC facility both 1 EA 40.73 40.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium acid phosphate 500 mg Tab [INYO] RXP01820 CDM 00486-1111-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium acid phosphate 500 mg Tab [inyo] RXP01820 CDM 39328-0008-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium citrate 10 mEq ER Tab [INYO] RXP01821 CDM 68084-0850-32 NDC facility both 1 EA 17.36 17.36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium citrate 10 mEq ER Tab [INYO] RXP01821 CDM 42543-0407-01 NDC facility both 1 EA 14.73 14.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium citrate 10 mEq ER Tab [INYO] RXP01821 CDM 00245-0071-11 NDC facility both 1 EA 16.55 16.55 Gross Charge Type: Pharmacy | NDC EA = 1 TAB potassium phosphate-sodium phosphate 250 mg-280 mg-160 mg Pow UD [INYO] RXP01826 CDM 60258-0006-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS olmesartan 20 mg Tab [INYO] RXP01836 CDM 68462-0437-30 NDC facility both 1 EA 41.47 41.47 Gross Charge Type: Pharmacy | NDC EA = 1 TAB olmesartan 20 mg Tab [INYO] RXP01836 CDM 65597-0103-30 NDC facility both 1 EA 55.44 55.44 Gross Charge Type: Pharmacy | NDC EA = 1 TAB olopatadine ophthalmic 0.1% Sol [inyo] RXP01837 CDM 70000-0054-01 NDC facility both 1 EA 83.94 83.94 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS olopatadine ophthalmic 0.1% Sol [inyo] RXP01837 CDM 00536-1308-40 NDC facility both 1 EA 109.5 109.5 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS olopatadine Ophth 0.1% Sol [INYO] RXP01837 CDM 00065-0271-05 NDC facility both 1 EA 1394.92 1394.92 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS OLANZapine 10 mg Dis Tab [INYO] RXP01838 CDM 60505-3276-00 NDC facility both 1 EA 104.87 104.87 Gross Charge Type: Pharmacy | NDC EA = 1 TAB OLANZapine 10 mg Dis Tab [INYO] RXP01838 CDM 00002-4454-85 NDC facility both 1 EA 148.26 148.26 Gross Charge Type: Pharmacy | NDC EA = 1 TAB OLANZapine 10 mg Dis Tab [INYO] RXP01838 CDM 00093-5246-65 NDC facility both 1 EA 104.87 104.87 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Multiple Vitamins and Minerals Tab [INYO] RXP01839 CDM 24208-0387-60 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Multiple Vitamins and Minerals Tab [INYO] RXP01839 CDM 24208-0387-62 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB nortriptyline 10 mg Cap UD [INYO] RXP01840 CDM 50268-0603-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP nortriptyline 10 mg Cap UD [INYO] RXP01840 CDM 60687-0281-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP mycophenolate mofetil 500 mg Tab [INYO] RXP01845 CDM J7517 HCPCS 60687-0438-01 NDC facility both 1 EA 9.38 9.38 Gross Charge Type: Pharmacy | NDC EA = 1 TAB mycophenolate mofetil 500 mg Tab [INYO] RXP01845 CDM J7517 HCPCS 50268-0558-15 NDC facility both 1 EA 6.82 6.82 Gross Charge Type: Pharmacy | NDC EA = 1 TAB mycophenolate mofetil 500 mg Tab [INYO] RXP01845 CDM J7517 HCPCS 00904-7078-61 NDC facility both 1 EA 6.82 6.82 Gross Charge Type: Pharmacy | NDC EA = 1 TAB mycophenolate mofetil 500 mg Tab [INYO] RXP01845 CDM J7517 HCPCS 16729-0019-01 NDC facility both 1 EA 47.08 47.08 Gross Charge Type: Pharmacy | NDC EA = 1 TAB mycophenolate mofetil 250 mg Cap [INYO] RXP01846 CDM J7517 HCPCS 00004-0259-01 NDC facility both 1 EA 53.98 53.98 Gross Charge Type: Pharmacy | NDC EA = 1 CAP moxifloxacin 400 mg Tab [INYO] RXP01848 CDM 00904-6406-04 NDC facility both 1 EA 55.54 55.54 Gross Charge Type: Pharmacy | NDC EA = 1 TAB moxifloxacin 400 mg Tab [INYO] RXP01848 CDM 50268-0576-13 NDC facility both 1 EA 133.58 133.58 Gross Charge Type: Pharmacy | NDC EA = 1 TAB moxifloxacin 400 mg Tab [INYO] RXP01848 CDM 00904-6406-06 NDC facility both 1 EA 149.65 149.65 Gross Charge Type: Pharmacy | NDC EA = 1 TAB mometasone Nasal 50 mcg/inh Spry [INYO] RXP01852 CDM 00085-1288-01 NDC facility both 1 EA 1206.88 1206.88 Gross Charge Type: Pharmacy | NDC EA = 17 SPRAYS moexipril 15 mg Tab [INYO] RXP01853 CDM 00093-5150-01 NDC facility both 1 EA 8.73 8.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB minocycline 100 mg Cap [INYO] RXP01856 CDM 00591-5695-50 NDC facility both 1 EA 20.38 20.38 Gross Charge Type: Pharmacy | NDC EA = 1 CAP midodrine 5 mg Tab [INYO] RXP01858 CDM 00904-6818-61 NDC facility both 1 EA 6.24 6.24 Gross Charge Type: Pharmacy | NDC EA = 1 TAB midodrine 5 mg Tab [INYO] RXP01858 CDM 63739-0145-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB midodrine 5 mg Tab [INYO] RXP01858 CDM 60687-0398-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB midodrine 5 mg Tab [INYO] RXP01858 CDM 00245-0212-01 NDC facility both 1 EA 26.93 26.93 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methyldopa 250 mg Tab [INYO] RXP01862 CDM 16729-0030-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methyldopa 250 mg Tab [INYO] RXP01862 CDM 51079-0200-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methotrexate 2.5 mg Tab [INYO] RXP01864 CDM J8610 HCPCS 47335-0235-96 NDC facility both 1 EA 24.3 24.3 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methotrexate 2.5 mg Tab [INYO] RXP01864 CDM J8610 HCPCS 00054-8550-25 NDC facility both 1 EA 21.38 21.38 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metFORMIN 500 mg ER Tab [INYO] RXP01866 CDM 62756-0142-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metFORMIN 500 mg ER Tab [INYO] RXP01866 CDM 60687-0640-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metFORMIN 500 mg ER Tab [INYO] RXP01866 CDM 00904-5794-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB meropenem 1 g IV Inj [INYO] RXP01867 CDM J2185 HCPCS 44567-0401-10 NDC facility both 1 EA 288 288 Gross Charge Type: Pharmacy meropenem 1 g IV Inj [INYO] RXP01867 CDM J2185 HCPCS 55150-0208-30 NDC facility both 1 EA 416 416 Gross Charge Type: Pharmacy mercaptopurine 50 mg Tab [INYO] RXP01868 CDM 00054-4581-27 NDC facility both 1 EA 43.07 43.07 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Vitamin B Complex with C and Folic Acid Tab [INYO] RXP01870 CDM 00536-1415-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Vitamin B Complex with C and Folic Acid Tab [INYO] RXP01870 CDM 00536-7300-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sulindac 200 mg Tab [INYO] RXP01876 CDM 00378-0531-01 NDC facility both 1 EA 7.24 7.24 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "pancrelipase 3000 units-9500 units-15,000 units Cap [INYO]" RXP01879 CDM 00032-1203-70 NDC facility both 1 EA 10.16 10.16 Gross Charge Type: Pharmacy | NDC EA = 1 CAP imipenem-cilastatin 500 mg Inj [INYO] RXP01881 CDM J0743 HCPCS 63323-0322-25 NDC facility both 1 EA 240 240 Gross Charge Type: Pharmacy imipenem-cilastatin 500 mg Inj [INYO] RXP01881 CDM J0743 HCPCS 44567-0705-10 NDC facility both 1 EA 262.56 262.56 Gross Charge Type: Pharmacy imipenem-cilastatin 500 mg Inj [INYO] RXP01881 CDM J0743 HCPCS 00006-3516-59 NDC facility both 1 EA 313.45 313.45 Gross Charge Type: Pharmacy sildenafil 25 mg Tab [INYO] RXP01883 CDM 13668-0186-30 NDC facility both 1 EA 66.46 66.46 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sildenafil 25 mg Tab [INYO] RXP01883 CDM 00069-4200-30 NDC facility both 1 EA 356.08 356.08 Gross Charge Type: Pharmacy | NDC EA = 1 TAB palonosetron 0.25 mg/5 mL IV Sol [INYO] RXP01889 CDM J2469 HCPCS 00703-4094-01 NDC facility both 5 ML 720 720 Gross Charge Type: Pharmacy palonosetron 0.25 mg/5 mL IV Sol [INYO] RXP01889 CDM J2469 HCPCS 62856-0797-01 NDC facility both 5 ML 1520 1520 Gross Charge Type: Pharmacy palonosetron 0.25 mg/5 mL IV Sol [INYO] RXP01889 CDM J2469 HCPCS 60505-6193-01 NDC facility both 5 ML 1520 1520 Gross Charge Type: Pharmacy morphine 2 mg/mL Sol CARP [INYO] RXP01890 CDM J2274 HCPCS 00409-1890-01 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy leuprolide 22.5 mg/3 months Kit [INYO] RXP01895 CDM J9217 HCPCS 00074-3346-03 NDC facility both 1 EA 15200 15200 Gross Charge Type: Pharmacy metFORMIN 750 mg ER Tab [INYO] RXP01896 CDM 62756-0143-01 NDC facility both 1 EA 7.18 7.18 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amiodarone 900 mg/18 mL IV Sol [INYO] RXP01898 CDM J0282 HCPCS 67457-0153-18 NDC facility both 18 ML 235 235 Gross Charge Type: Pharmacy sildenafil 20 mg oral tablet [INYO] RXP01900 CDM 00904-6671-04 NDC facility both 1 EA 8.36 8.36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sildenafil 20 mg Tab [inyo] RXP01900 CDM 63739-0072-33 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sildenafil 20 mg oral tablet [INYO] RXP01900 CDM 00069-4190-68 NDC facility both 1 EA 260 260 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tamoxifen 20 mg Tab [INYO] RXP01905 CDM 00378-0274-93 NDC facility both 1 EA 22.73 22.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tamoxifen 20 mg Tab [INYO] RXP01905 CDM 59651-0300-30 NDC facility both 1 EA 22.73 22.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levalbuterol CFC free 45 mcg/inh Inh Aer w/adapter [INYO] RXP01909 CDM 63402-0510-01 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 15 INH morphine 100 mg/8 to 12 hr UD [INYO] RXP01910 CDM 00406-8390-62 NDC facility both 1 EA 38.18 38.18 Gross Charge Type: Pharmacy | NDC EA = 1 TAB liothyronine 5 mcg Tab [INYO] RXP01912 CDM 51862-0320-01 NDC facility both 1 EA 11.34 11.34 Gross Charge Type: Pharmacy | NDC EA = 1 TAB liothyronine 5 mcg Tab [INYO] RXP01912 CDM 42794-0018-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrocortisone-pramoxine 1%-1% TOPICAL [INYO] RXP01915 CDM 49908-0150-30 NDC facility both 1 EA 333.68 333.68 Gross Charge Type: Pharmacy | NDC EA = 30 APP DULoxetine 20 mg Cap [INYO] RXP01917 CDM 00904-7043-61 NDC facility both 1 EA 11.55 11.55 Gross Charge Type: Pharmacy | NDC EA = 1 CAP DULoxetine 20 mg Cap [INYO] RXP01917 CDM 68084-0675-21 NDC facility both 1 EA 48.99 48.99 Gross Charge Type: Pharmacy | NDC EA = 1 CAP DULoxetine 20 mg Cap [INYO] RXP01917 CDM 60687-0723-21 NDC facility both 1 EA 48.99 48.99 Gross Charge Type: Pharmacy | NDC EA = 1 CAP DULoxetine 20 mg Cap [INYO] RXP01917 CDM 00904-7043-04 NDC facility both 1 EA 10.48 10.48 Gross Charge Type: Pharmacy | NDC EA = 1 CAP DULoxetine 20 mg Cap [INYO] RXP01917 CDM 00904-6452-04 NDC facility both 1 EA 10.48 10.48 Gross Charge Type: Pharmacy | NDC EA = 1 CAP DULoxetine 20 mg Cap [INYO] RXP01917 CDM 00904-6452-61 NDC facility both 1 EA 35.55 35.55 Gross Charge Type: Pharmacy | NDC EA = 1 CAP moxifloxacin 400 mg/250 mL IV Sol [INYO] RXP01919 CDM J2280 HCPCS 67457-0323-25 NDC facility both 250 ML 430 430 Gross Charge Type: Pharmacy methylnaltrexone 12 mg/0.6 mL SC Sol [INYO] RXP01929 CDM J2212 HCPCS 65649-0551-02 NDC facility both 0.6 ML 1520 1520 Gross Charge Type: Pharmacy methylnaltrexone 12 mg/0.6 mL SC Sol [INYO] RXP01929 CDM J2212 HCPCS 65649-0551-03 NDC facility both 0.6 ML 1196.78 1196.78 Gross Charge Type: Pharmacy goserelin 3.6 mg SubQ Imp [INYO] RXP01931 CDM J9202 HCPCS 00310-0950-36 NDC facility both 1 EA 3002.7 3002.7 Gross Charge Type: Pharmacy zoledronic acid 5 mg/100 mL IV Sol [INYO] RXP01932 CDM J3489 HCPCS 55111-0688-52 NDC facility both 100 ML 2160 2160 Gross Charge Type: Pharmacy zoledronic acid 5 mg/100 mL Sol RXP01932 CDM J3489 HCPCS 63323-0966-00 NDC facility both 100 ML 2160 2160 Gross Charge Type: Pharmacy zoledronic acid 5 mg/100 mL IV Sol [INYO] RXP01932 CDM J3489 HCPCS 25021-0830-82 NDC facility both 100 ML 2520 2520 Gross Charge Type: Pharmacy zoledronic acid 5 mg/100 mL IV Sol [INYO] RXP01932 CDM J3489 HCPCS 67457-0794-10 NDC facility both 100 ML 2625 2625 Gross Charge Type: Pharmacy methadone 10 mg Tab [INYO] RXP01938 CDM S0109 HCPCS 00904-6530-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ondansetron 4 mg Dis Tab [INYO] RXP01940 CDM Q0162 HCPCS 68462-0157-13 NDC facility both 1 EA 29.16 29.16 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ondansetron 4 mg Dis Tab [INYO] RXP01940 CDM Q0162 HCPCS 65862-0390-10 NDC facility both 1 EA 111.46 111.46 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ondansetron 4 mg Dis Tab [INYO] RXP01940 CDM Q0162 HCPCS 62756-0240-64 NDC facility both 1 EA 111.25 111.25 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ondansetron 4 mg Dis Tab [INYO] RXP01940 CDM Q0162 HCPCS 00781-5238-64 NDC facility both 1 EA 111.46 111.46 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cholecalciferol 1000 intl units oral tablet [INYO] RXP01941 CDM 00904-5824-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cholecalciferol 1000 intl units oral tablet [INYO] RXP01941 CDM 48433-0104-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cholecalciferol 1000 intl units oral tablet [INYO] RXP01941 CDM 35046-0001-05 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "fentaNYL 12 mcg/hr TD film, ER [INYO]" RXP01944 CDM 47781-0423-47 NDC facility both 1 EA 101.51 101.51 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES Sodium Chloride 0.45% with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP01946 CDM J3480 HCPCS 00409-9257-39 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.45% with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP01946 CDM J3480 HCPCS 00338-0704-34 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy cetuximab 100 mg/ 50 mL IV Sol [INYO] RXP01949 CDM J9055 HCPCS 66733-0948-23 NDC facility both 50 ML 3939.8 3939.8 Gross Charge Type: Pharmacy azithromycin 500 mg IV Inj [INYO] RXP01952 CDM J0456 HCPCS 55150-0174-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy azithromycin 500 mg IV Inj [INYO] RXP01952 CDM J0456 HCPCS 70436-0019-82 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy azithromycin 500 mg IV Inj [INYO] RXP01952 CDM J0456 HCPCS 00409-0144-11 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy azithromycin 500 mg IV Inj [INYO] RXP01952 CDM J0456 HCPCS 62756-0512-44 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy azithromycin 500 mg IV Inj [INYO] RXP01952 CDM J0456 HCPCS 00069-3150-83 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy pregabalin 25 mg oral capsule [INYO] RXP01955 CDM 00071-1012-68 NDC facility both 1 EA 49.11 49.11 Gross Charge Type: Pharmacy | NDC EA = 1 CAP pregabalin 25 mg oral capsule [INYO] RXP01955 CDM 00904-6991-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP pregabalin 25 mg oral capsule [INYO] RXP01955 CDM 60687-0473-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP pregabalin 25 mg oral capsule [INYO] RXP01955 CDM 00904-6991-04 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP enoxaparin 120 mg/0.8 mL SC Sol [INYO] RXP01956 CDM J1650 HCPCS 00548-5636-00 NDC facility both 0.8 ML 633.6 633.6 Gross Charge Type: Pharmacy enoxaparin 120 mg/0.8 mL SC Sol [INYO] RXP01956 CDM J1650 HCPCS 71288-0411-81 NDC facility both 0.8 ML 235 235 Gross Charge Type: Pharmacy enoxaparin 120 mg/0.8 mL SC Sol [INYO] RXP01956 CDM J1650 HCPCS 00781-3298-68 NDC facility both 0.8 ML 268.32 268.32 Gross Charge Type: Pharmacy DOCEtaxel 10 mg/mL [INYO] RXP01958 CDM J9171 HCPCS 00409-0201-02 NDC facility both 2 ML 577.5 577.5 Gross Charge Type: Pharmacy atropine 0.1 mg/mL Inj Sol [INYO] RXP01960 CDM J0461 HCPCS 76329-3340-01 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy atropine 0.1 mg/mL Inj Sol [INYO] RXP01960 CDM J0461 HCPCS 00409-1630-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy atropine 0.1 mg/mL Inj Sol [INYO] RXP01960 CDM J0461 HCPCS 00409-4911-34 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy atropine 1 mg/mL Inj Sol [INYO] RXP01961 CDM J0461 HCPCS 16729-0526-08 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy atropine 1 mg/mL Inj Sol [INYO] RXP01961 CDM J0461 HCPCS 00517-1010-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy cefdinir 250 mg/5 mL Oral Susp [INYO] RXP01963 CDM 67877-0548-98 NDC facility both 60 ML 397.12 397.12 Gross Charge Type: Pharmacy cefdinir 250 mg/5 mL Pow [inyo] RXP01963 CDM 65862-0219-60 NDC facility both 60 ML 397.4 397.4 Gross Charge Type: Pharmacy cefdinir 250 mg/5 mL Oral Susp [INYO] RXP01963 CDM 68180-0723-20 NDC facility both 60 ML 397.92 397.92 Gross Charge Type: Pharmacy cefdinir 250 mg/5 mL Oral Susp [INYO] RXP01963 CDM 68180-0723-04 NDC facility both 60 ML 397.92 397.92 Gross Charge Type: Pharmacy miSOPROStol 25 mcg Tab [INYO] rxp01965 CDM 70954-0443-10 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 - miSOPROStol 25 mcg Tab [INYO] rxp01965 CDM 59762-5007-01 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 - methylPREDNISolone acetate 80 mg/mL Inj Susp [INYO] RXP01966 CDM J1010 HCPCS 70121-1574-05 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy methylPREDNISolone acetate 80 mg/mL Inj Susp [INYO] RXP01966 CDM J1010 HCPCS 00009-3475-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy atazanavir 300 mg oral capsule [INYO] RXP01971 CDM 00003-3622-12 NDC facility both 1 EA 260 260 Gross Charge Type: Pharmacy | NDC EA = 1 CAP busPIRone 15 mg Tab [INYO] RXP01972 CDM 00904-6899-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB busPIRone 15 mg Tab [INYO] RXP01972 CDM 51079-0960-20 NDC facility both 1 EA 12.11 12.11 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "carvedilol 20 mg oral Cap, ER [INYO]" RXP01982 CDM 00007-3371-13 NDC facility both 1 EA 55.05 55.05 Gross Charge Type: Pharmacy | NDC EA = 1 CAP cefdinir 300 mg Cap [INYO] RXP01983 CDM 60687-0699-21 NDC facility both 1 EA 24.29 24.29 Gross Charge Type: Pharmacy | NDC EA = 1 CAP cefdinir 300 mg Cap [INYO] RXP01983 CDM 65862-0177-60 NDC facility both 1 EA 30.65 30.65 Gross Charge Type: Pharmacy | NDC EA = 1 CAP cefdinir 300 mg Cap [INYO] RXP01983 CDM 00781-2176-60 NDC facility both 1 EA 30.68 30.68 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ubiquinone 100 mg oral capsule [INYO] RXP01987 CDM 00904-5882-46 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP erlotinib 150 mg Tab [INYO] RXP01993 CDM 50242-0064-01 NDC facility both 1 EA 1292.61 1292.61 Gross Charge Type: Pharmacy | NDC EA = 1 TAB febuxostat 80 mg Tab [INYO] RXP01995 CDM 00378-3926-93 NDC facility both 1 EA 59.34 59.34 Gross Charge Type: Pharmacy | NDC EA = 1 TAB itraconazole 100 mg Cap [INYO] RXP02003 CDM 00185-0550-83 NDC facility both 1 EA 55.82 55.82 Gross Charge Type: Pharmacy | NDC EA = 1 CAP itraconazole 100 mg Cap [INYO] RXP02003 CDM 67877-0454-30 NDC facility both 1 EA 120.73 120.73 Gross Charge Type: Pharmacy | NDC EA = 1 CAP lamoTRIgine 25 mg Tab [INYO] RXP02005 CDM 00904-7007-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lamoTRIgine 25 mg Tab [INYO] RXP02005 CDM 51079-0498-20 NDC facility both 1 EA 24.96 24.96 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 137 mcg (0.137 mg) Tab [INYO] RXP02008 CDM 60687-0563-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 137 mcg (0.137 mg) Tab [INYO] RXP02008 CDM 42292-0041-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 137 mcg (0.137 mg) Tab [INYO] RXP02008 CDM 00074-3727-90 NDC facility both 1 EA 9.36 9.36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lithium 150 mg Cap [INYO] RXP02009 CDM 00054-8526-25 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP lubiprostone 8 mcg Cap [INYO] RXP02011 CDM 64764-0080-60 NDC facility both 1 EA 44.53 44.53 Gross Charge Type: Pharmacy | NDC EA = 1 CAP melatonin 3 mg Tab [INYO] RXP02012 CDM 20555-0036-00 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB melatonin 3 mg Tab [INYO] RXP02012 CDM 00904-5182-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methimazole 10 mg Tab [INYO] RXP02014 CDM 60687-0370-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB methIMAzole 10 mg Tab RXP02014 CDM 60687-0680-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB nateglinide 120 mg Tab [INYO] RXP02016 CDM 00078-0352-05 NDC facility both 1 EA 26.92 26.92 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxybutynin 5 mg ER Tab [INYO] RXP02020 CDM 00904-6570-06 NDC facility both 1 EA 20.15 20.15 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rOPINIRole 0.25 mg Tab [INYO] RXP02027 CDM 50268-0741-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB solifenacin 5 mg Tab [INYO] RXP02029 CDM 68462-0386-30 NDC facility both 1 EA 73.25 73.25 Gross Charge Type: Pharmacy | NDC EA = 1 TAB solifenacin 5 mg Tab [INYO] RXP02029 CDM 51248-0150-52 NDC facility both 1 EA 62.95 62.95 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tadalafil 10 mg Tab [INYO] RXP02031 CDM 00002-4463-30 NDC facility both 1 EA 333.6 333.6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB triamterene 100 mg Cap [INYO] RXP02035 CDM 65197-0003-01 NDC facility both 1 EA 57.48 57.48 Gross Charge Type: Pharmacy | NDC EA = 1 CAP oxytocin 30 units/500 mL-NaCl 0.9% Sol [INYO] RXP02041 CDM J2590 HCPCS 71266-5103-01 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy oxytocin 30 units/500 mL-NaCl 0.9% Sol [INYO] RXP02041 CDM J2590 HCPCS 70092-1552-07 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy levalbuterol 1.25 mg/0.5 mL Sol [inyo] RXP02043 CDM J7612 HCPCS 00378-6993-93 NDC facility both 1 ML 40.2 40.2 Gross Charge Type: Pharmacy levalbuterol 1.25 mg/0.5 mL Inh Sol [INYO] RXP02043 CDM J7612 HCPCS 00093-4147-56 NDC facility both 1 ML 40.2 40.2 Gross Charge Type: Pharmacy levalbuterol 1.25 mg/0.5 mL Inh Sol [INYO] RXP02043 CDM J7612 HCPCS 17478-0171-01 NDC facility both 1 ML 40.2 40.2 Gross Charge Type: Pharmacy lamoTRIgine 100 mg Tab [INYO] RXP02046 CDM 00904-7008-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lamoTRIgine 100 mg Tab [INYO] RXP02046 CDM 51079-0499-20 NDC facility both 1 EA 28.51 28.51 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lamoTRIgine 100 mg Tab [INYO] RXP02046 CDM 68084-0319-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lamoTRIgine 100 mg Tab [INYO] RXP02046 CDM 65862-0228-01 NDC facility both 1 EA 28.51 28.51 Gross Charge Type: Pharmacy | NDC EA = 1 TAB denosumab 60 mg/mL [INYO] RXP02047 CDM J0897 HCPCS 55513-0710-01 NDC facility both 1 ML 10020 10020 Gross Charge Type: Pharmacy cefepime 1 g Inj [INYO] RXP02049 CDM J0692 HCPCS 25021-0121-20 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefepime 1 g Inj [INYO] RXP02049 CDM J0692 HCPCS 44567-0240-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefepime 1 g Inj [INYO] RXP02049 CDM J0692 HCPCS 60505-6146-04 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy bendamustine 25 mg/mL [INYO] RXP02050 CDM J9034 HCPCS 63459-0348-04 NDC facility both 4 ML 12645 12645 Gross Charge Type: Pharmacy dimethyl sulfoxide 50% Irr Sol 50 mL [INYO] RXP02051 CDM J1212 HCPCS 67457-0177-50 NDC facility both 50 ML 2969.24 2969.24 Gross Charge Type: Pharmacy acetylcysteine 20% IV Sol 30 mL [INYO] RXP02053 CDM J0132 HCPCS 63323-0963-30 NDC facility both 30 ML 1056 1056 Gross Charge Type: Pharmacy acetylcysteine 20% IV Sol 30 mL [INYO] RXP02053 CDM J0132 HCPCS 66220-0207-30 NDC facility both 30 ML 1552.41 1552.41 Gross Charge Type: Pharmacy acetylcysteine 20% IV Sol 30 mL [INYO] RXP02053 CDM J0132 HCPCS 25021-0812-30 NDC facility both 30 ML 1520 1520 Gross Charge Type: Pharmacy fentaNYL 100 mcg/2 mL AMP Sol [INYO] RXP02055 CDM J3010 HCPCS 00409-9093-32 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy rifampin 600 mg IV Inj [INYO] RXP02056 CDM 00068-0597-01 NDC facility both 1 EA 642.81 642.81 Gross Charge Type: Pharmacy caffeine-sodium benzoate 250mg/2mL Inj[INYO] RXP02057 CDM 00517-2502-10 NDC facility both 2 ML 330 330 Gross Charge Type: Pharmacy Sodium Chloride 3% IV Sol 500 mL [INYO] RXP02060 CDM J7131 HCPCS 00264-7805-10 NDC facility both 500 ML 265 265 Gross Charge Type: Pharmacy fosaprepitant 150 mg Pow [INYO] RXP02061 CDM J1453 HCPCS 71839-0104-01 NDC facility both 1 EA 1083 1083 Gross Charge Type: Pharmacy fosaprepitant 150 mg Pow [INYO] RXP02061 CDM J1453 HCPCS 00006-3061-00 NDC facility both 1 EA 1204.68 1204.68 Gross Charge Type: Pharmacy fosaprepitant 150 mg Pow [INYO] RXP02061 CDM J1453 HCPCS 72205-0054-01 NDC facility both 1 EA 963.75 963.75 Gross Charge Type: Pharmacy azaCITIDine 100 mg Inj [INYO] RXP02062 CDM J9025 HCPCS 64679-0096-01 NDC facility both 1 EA 845 845 Gross Charge Type: Pharmacy azaCITIDine 100 mg Inj [INYO] RXP02062 CDM J9025 HCPCS 59572-0102-01 NDC facility both 1 EA 2799.4 2799.4 Gross Charge Type: Pharmacy bortezomib 3.5 mg IV Inj [INYO] RXP02063 CDM J9041 HCPCS 63020-0049-01 NDC facility both 1 EA 9618 9618 Gross Charge Type: Pharmacy Take Home Ondansetron ODT 4 mg #3 [INYO] RXP02064 CDM 68071-4115-30 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Ondansetron ODT 4 mg #3 [INYO] RXP02064 CDM 00781-5238-64-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "penicillin G benzathine 1,200,000 units/2 mL Sus [INYO]" RXP02065 CDM J0561 HCPCS 60793-0701-10 NDC facility both 2 ML 1520 1520 Gross Charge Type: Pharmacy magnesium sulfate 2 g/50 mL-sterile water [INYO] RXP02066 CDM J3475 HCPCS 44567-0420-24 NDC facility both 50 ML 265 265 Gross Charge Type: Pharmacy magnesium sulfate 2 g/50 mL-sterile water [INYO] RXP02066 CDM J3475 HCPCS 63323-0106-05 NDC facility both 50 ML 265 265 Gross Charge Type: Pharmacy magnesium sulfate 2 g/50 mL-sterile water Sol [INYO] RXP02066 CDM J3475 HCPCS 47335-0992-01 NDC facility both 50 ML 2265.12 2265.12 Gross Charge Type: Pharmacy magnesium sulfate 2 g/50 mL-sterile water Sol [INYO] RXP02066 CDM J3475 HCPCS 00264-4204-52 NDC facility both 50 ML 265 265 Gross Charge Type: Pharmacy magnesium sulfate 2 g/50 mL-sterile water [INYO] RXP02066 CDM J3475 HCPCS 00409-6729-24 NDC facility both 50 ML 265 265 Gross Charge Type: Pharmacy tocilizumab 80 mg/4mL [INYO] RXP02067 CDM J3262 HCPCS 50242-0135-01 NDC facility both 4 ML 2686.4 2686.4 Gross Charge Type: Pharmacy Dextrose 5% with NS and KCl 40 mEq/l IV Sol 1000 mL [INYO] RXP02068 CDM J3480 HCPCS 00409-7109-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy dabigatran 150 mg Cap UD [INYO] RXP02072 CDM 00597-0360-82 NDC facility both 1 EA 55.03 55.03 Gross Charge Type: Pharmacy | NDC EA = 1 CAP levETIRAcetam 500 mg/5 mL Sol [INYO] RXP02074 CDM J1953 HCPCS 00143-9673-25 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy levETIRAcetam 500 mg/5 mL IV Sol [INYO] RXP02074 CDM J1953 HCPCS 51224-0013-25 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy levETIRAcetam 500 mg/5 mL IV Sol [INYO] RXP02074 CDM J1953 HCPCS 00409-1886-02 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy lidocaine 4% PF Inj Sol 5 mL [INYO] RXP02076 CDM J2001 HCPCS 00409-4283-01 NDC facility both 5 EA 25.98 25.98 Gross Charge Type: Pharmacy leuprolide 45 mg/6 months Kit [INYO] RXP02079 CDM J9217 HCPCS 00074-3473-03 NDC facility both 1 EA 36794.25 36794.25 Gross Charge Type: Pharmacy cholecalciferol 400 intl units/0.028 mL DROPS [INYO] RXP02080 CDM 51228-0000-06 NDC facility both 1 EA 67.35 67.35 Gross Charge Type: Pharmacy | NDC EA = 2.5 DROPS pertuzumab 420 mg/14 mL [INYO] RXP02081 CDM J9306 HCPCS 50242-0145-01 NDC facility both 14 ML 15413.6 15413.6 Gross Charge Type: Pharmacy denosumab 120 mg/1.7 mL [INYO] RXP02082 CDM J0897 HCPCS 55513-0730-01 NDC facility both 1.7 ML 10020 10020 Gross Charge Type: Pharmacy bupivacaine liposome 1.3% (13.3 mg/mL) Sus [INYO] RXP02083 CDM C9290 HCPCS 65250-0266-09 NDC facility both 20 ML 2629.19 2629.19 Gross Charge Type: Pharmacy bupivacaine liposome 1.3% (13.3 mg/mL) Sus [INYO] RXP02083 CDM C9290 HCPCS 65250-0266-20 NDC facility both 20 ML 2267.96 2267.96 Gross Charge Type: Pharmacy certolizumab 200 mg/mL Kit [INYO] RXP02084 CDM J0717 HCPCS 50474-0710-79 NDC facility both 1 EA 12645 12645 Gross Charge Type: Pharmacy belimumab 400 mg Pow [INYO] RXP02085 CDM J0490 HCPCS 49401-0102-01 NDC facility both 1 EA 10677.12 10677.12 Gross Charge Type: Pharmacy eriBULin 1 mg/2 mL [INYO] RXP02087 CDM J9179 HCPCS 62856-0389-01 NDC facility both 2 ML 7008 7008 Gross Charge Type: Pharmacy rifAXIMin 550 mg Tab UD [INYO] RXP02088 CDM 65649-0303-03 NDC facility both 1 EA 260 260 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tranexamic acid 100 mg/mL Sol [INYO] RXP02089 CDM 55150-0188-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy tranexamic acid 1000 mg/10mL IV Sol [INYO] RXP02089 CDM 60505-6169-01 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy tranexamic acid 1000 mg/10mL IV Sol [INYO] RXP02089 CDM 00013-1114-21 NDC facility both 10 ML 289.44 289.44 Gross Charge Type: Pharmacy tranexamic acid 1000 mg/10mL IV Sol [INYO] RXP02089 CDM 69543-0376-22 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy tranexamic acid 1000 mg/10mL IV Sol [INYO] RXP02089 CDM 00013-1114-10 NDC facility both 10 ML 288 288 Gross Charge Type: Pharmacy regadenoson 0.4 mg/5 mL Sol [INYO] RXP02090 CDM J2785 HCPCS 76329-3321-00 NDC facility both 5 ML 288 288 Gross Charge Type: Pharmacy regadenoson 0.4 mg/5 mL Sol [inyo] RXP02090 CDM J2785 HCPCS 60505-6116-00 NDC facility both 5 ML 1801.8 1801.8 Gross Charge Type: Pharmacy regadenoson 0.4 mg / 5 mL Soln [INYO] RXP02090 CDM J2785 HCPCS 71288-0201-85 NDC facility both 5 ML 1520 1520 Gross Charge Type: Pharmacy regadenoson 0.4 mg/5 mL IV Sol [INYO] RXP02090 CDM J2785 HCPCS 00469-6501-89 NDC facility both 5 ML 1749.3 1749.3 Gross Charge Type: Pharmacy cefepime 2 g Pow [inyo] RXP02091 CDM J0692 HCPCS 44567-0131-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefepime 2 g Inj [INYO] RXP02091 CDM J0692 HCPCS 44567-0241-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefepime 2 g Inj [INYO] RXP02091 CDM J0692 HCPCS 25021-0122-50 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefepime 2 g Inj [INYO] RXP02091 CDM J0692 HCPCS 70594-0090-02 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefepime 2 g Inj [INYO] RXP02091 CDM J0692 HCPCS 60505-6147-04 NDC facility both 1 EA 322.85 322.85 Gross Charge Type: Pharmacy zoledronic acid 4 mg/5 mL IV Sol [INYO] RXP02094 CDM J3489 HCPCS 54288-0100-01 NDC facility both 5 ML 330 330 Gross Charge Type: Pharmacy zoledronic acid 4 mg/5 mL Sol [INYO] RXP02094 CDM J3489 HCPCS 55111-0685-07 NDC facility both 5 ML 330 330 Gross Charge Type: Pharmacy zoledronic acid 4 mg/5 mL IV Sol [INYO] RXP02094 CDM J3489 HCPCS 25021-0801-66 NDC facility both 5 ML 648 648 Gross Charge Type: Pharmacy zoledronic acid 4 mg/5 mL IV Sol [INYO] RXP02094 CDM J3489 HCPCS 16729-0242-31 NDC facility both 5 ML 2514.87 2514.87 Gross Charge Type: Pharmacy zoledronic acid 4 mg/5 mL IV Sol [INYO] RXP02094 CDM J3489 HCPCS 67457-0390-54 NDC facility both 5 ML 330 330 Gross Charge Type: Pharmacy piperacillin-tazobactam 2.25 g IV Inj [INYO] RXP02096 CDM J2543 HCPCS 55150-0119-30 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 3.375 g IV Inj [INYO] RXP02097 CDM J2543 HCPCS 55150-0120-30 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 3.375 g IV Inj [INYO] RXP02097 CDM J2543 HCPCS 60505-6157-04 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 3 g-0.375 g Pow [inyo] RXP02097 CDM J2543 HCPCS 81284-0152-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 3 g-0.375 g Pow [INYO] RXP02097 CDM J2543 HCPCS 00781-3113-95 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 3.375 g IV Inj [INYO] RXP02097 CDM J2543 HCPCS 64679-0056-01 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 4.5 g IV Inj [INYO] RXP02098 CDM J2543 HCPCS 60505-6159-04 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 4.5 g IV Inj [INYO] RXP02098 CDM J2543 HCPCS 55150-0121-50 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 4.5 g IV Inj [INYO] RXP02098 CDM J2543 HCPCS 00409-3390-04 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy piperacillin-tazobactam 4.5 g IV Inj [INYO] RXP02098 CDM J2543 HCPCS 39822-0127-06 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy rivaroxaban 10 mg Tab [INYO] RXP02099 CDM 50458-0580-10 NDC facility both 1 EA 93.99 93.99 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rivaroxaban 10 mg Tab [INYO] RXP02099 CDM 50458-0580-30 NDC facility both 1 EA 93.99 93.99 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rivaroxaban 15 mg Tab [INYO] RXP02100 CDM 50458-0578-10 NDC facility both 1 EA 93.99 93.99 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rivaroxaban 15 mg Tab [INYO] RXP02100 CDM 50458-0578-30 NDC facility both 1 EA 93.99 93.99 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ceFAZolin 1 g PWVL [INYO] RXP02102 CDM J0690 HCPCS 00143-9924-90 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ceFAZolin 1 g PWVL [INYO] RXP02102 CDM J0690 HCPCS 44567-0120-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ceFAZolin 1 g PWVL [INYO] RXP02102 CDM J0690 HCPCS 44567-0707-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ipilimumab 5 mg/mL [INYO] RXP02103 CDM J9228 HCPCS 00003-2327-11 NDC facility both 10 ML 22504.23 22504.23 Gross Charge Type: Pharmacy HYDROmorphone 1 mg/mL PFS Inj Sol [INYO] RXP02104 CDM J1170 HCPCS 00409-1283-31 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy dexmedeTOMIDine 4 mcg/mL-NaCl 0.9% Sol [INYO] RXP02106 CDM 00338-9555-24 NDC facility both 50 ML 412.8 412.8 Gross Charge Type: Pharmacy dexmedetomidine 200 mcg/50 mL-NaCl 0.9% Sol [INYO] RXP02106 CDM 70121-1388-08 NDC facility both 50 ML 429.6 429.6 Gross Charge Type: Pharmacy dexmedetomidine 200 mcg/50 mL-NaCl 0.9% Sol [INYO] RXP02106 CDM 00409-1660-50 NDC facility both 50 ML 443.52 443.52 Gross Charge Type: Pharmacy dexmedetomidine 200 mcg/50 mL-NaCl 0.9% Sol [INYO] RXP02106 CDM 00781-3494-95 NDC facility both 50 ML 430 430 Gross Charge Type: Pharmacy dexmedetomidine 200 mcg/50 mL-NaCl 0.9% Sol [INYO] RXP02106 CDM 71225-0126-05 NDC facility both 50 ML 288 288 Gross Charge Type: Pharmacy silver topical - Gel [INYO] RXP02115 CDM 08327-0309-09 NDC facility both 1 EA 152.8 152.8 Gross Charge Type: Pharmacy | NDC EA = 45 APP zolpidem 5 mg Tab [INYO] RXP02117 CDM 13668-0007-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB zolpidem 5 mg Tab [INYO] RXP02117 CDM 00904-6082-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pneumococcal 13-valent conjugate vaccine - Sus UD [INYO] RXP02119 CDM 00005-1971-02 NDC facility both 0.5 ML 1520 1520 Gross Charge Type: Pharmacy cloNIDine 100 mcg/mL intrathecal Sol [INYO] RXP02120 CDM J0735 HCPCS 67457-0218-10 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy cloNIDine 100 mcg/mL intrathecal Sol [INYO] RXP02120 CDM J0735 HCPCS 39822-2000-01 NDC facility both 10 ML 330 330 Gross Charge Type: Pharmacy tobramycin Ophth 0.3% Sol [INYO] RXP02126 CDM 61314-0643-05 NDC facility both 1 EA 204 204 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS Mirena levonorgestrel 52 mg intrauteral Dev [INYO] RXP02130 CDM J7298 HCPCS 50419-0423-01 NDC facility both 1 EA 4576.84 4576.84 Gross Charge Type: Pharmacy pembrolizumab Keytruda 100 mg/4 mL [INYO] RXP02132 CDM J9271 HCPCS 00006-3026-02 NDC facility both 4 ML 17006.05 17006.05 Gross Charge Type: Pharmacy sugammadex 500 mg/ 5 mL Sol [INYO] RXP02133 CDM 00006-5425-15 NDC facility both 5 ML 1520 1520 Gross Charge Type: Pharmacy sugammadex 200 mg/2 mL [INYO] RXP02134 CDM 00006-5423-12 NDC facility both 2 ML 1005.31 1005.31 Gross Charge Type: Pharmacy calcitonin 400 intl units/2 mL Inj Sol [INYO] RXP02135 CDM J0630 HCPCS 00078-0149-23 NDC facility both 2 ML 10020 10020 Gross Charge Type: Pharmacy calcitonin 400 intl units/2 mL Inj Sol [INYO] RXP02135 CDM J0630 HCPCS 42023-0205-01 NDC facility both 2 ML 10020 10020 Gross Charge Type: Pharmacy calcitonin 400 intl units/2 mL Inj Sol [INYO] RXP02135 CDM J0630 HCPCS 24201-0400-02 NDC facility both 2 ML 10020 10020 Gross Charge Type: Pharmacy calcitonin 400 intl units/2 mL Inj Sol [INYO] RXP02135 CDM J0630 HCPCS 67457-0675-02 NDC facility both 2 ML 10020 10020 Gross Charge Type: Pharmacy OPDIVO 100 mg/10 mL Sol [INYO] RXP02136 CDM J9299 HCPCS 00003-3774-12 NDC facility both 10 ML 13358.3 13358.3 Gross Charge Type: Pharmacy Acetaminophen IV 1000 mg/100mL [INYO] RXP02138 CDM J0131 HCPCS 63323-0434-00 NDC facility both 100 ML 384 384 Gross Charge Type: Pharmacy Acetaminophen IV 1000 mg/100mL [INYO] RXP02138 CDM J0131 HCPCS 55150-0307-24 NDC facility both 100 ML 235 235 Gross Charge Type: Pharmacy Acetaminophen IV 1000 mg/100mL [INYO] RXP02138 CDM J0131 HCPCS 67457-0940-10 NDC facility both 100 ML 360 360 Gross Charge Type: Pharmacy Acetaminophen IV 1000 mg/100mL [INYO] RXP02138 CDM J0131 HCPCS 00264-4100-90 NDC facility both 100 ML 523.2 523.2 Gross Charge Type: Pharmacy Acetaminophen IV 1000 mg/100mL [INYO] RXP02138 CDM J0131 HCPCS 43825-0102-01 NDC facility both 100 ML 454.75 454.75 Gross Charge Type: Pharmacy Acetaminophen IV 1000 mg/100mL [INYO] RXP02138 CDM J0131 HCPCS 24201-0100-24 NDC facility both 100 ML 341.06 341.06 Gross Charge Type: Pharmacy Acetaminophen IV 1000 mg/100mL [INYO] RXP02138 CDM J0131 HCPCS 00781-3156-95 NDC facility both 100 ML 355.27 355.27 Gross Charge Type: Pharmacy apixaban 5 mg Tab [INYO] RXP02139 CDM 00003-0894-31 NDC facility both 1 EA 59.89 59.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB apixaban 5 mg Tab [INYO] RXP02139 CDM 00003-0894-21 NDC facility both 1 EA 56.5 56.5 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levonorgestrel 1.5 mg Tab [INYO] RXP02141 CDM 51285-0162-88 NDC facility both 1 EA 192.51 192.51 Gross Charge Type: Pharmacy prothrombin complex - Pow 1000 units [INYO] RXP02143 CDM J7168 HCPCS 63833-0387-02 NDC facility both 1 ML 6056.61 6056.61 Gross Charge Type: Pharmacy ziprasidone 20 mg Cap [INYO] RXP02144 CDM 00904-6269-45 NDC facility both 1 EA 19.86 19.86 Gross Charge Type: Pharmacy | NDC EA = 1 CAP micafungin 100 mg IV Inj [INYO] RXP02145 CDM J2248 HCPCS 00469-3211-10 NDC facility both 1 EA 673.2 673.2 Gross Charge Type: Pharmacy modafinil 100 mg Tab [INYO] RXP02146 CDM 50268-0570-12 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB modafinil 100 mg Tab [INYO] RXP02146 CDM 00904-6791-04 NDC facility both 1 EA 55.94 55.94 Gross Charge Type: Pharmacy | NDC EA = 1 TAB modafinil 100 mg Tab [INYO] RXP02146 CDM 00904-6423-04 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB zinc gluconate 50 mg Tab [INYO] RXP02147 CDM 00904-3191-60 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB zinc gluconate 50 mg Tab [INYO] RXP02147 CDM 40093-0101-53 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB zinc gluconate 50 mg Tab [INYO] RXP02147 CDM 11845-0691-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ENTYVIO 300 mg Pow [INYO] RXP02148 CDM J3380 HCPCS 64764-0300-20 NDC facility both 1 EA 24528.05 24528.05 Gross Charge Type: Pharmacy fomepizole 1 g/mL IV Sol [INYO] RXP02149 CDM J1451 HCPCS 00517-0710-01 NDC facility both 1.5 ML 6233.79 6233.79 Gross Charge Type: Pharmacy fomepizole 1 g/mL IV Sol [INYO] RXP02149 CDM J1451 HCPCS 39822-0710-01 NDC facility both 1.5 ML 3936 3936 Gross Charge Type: Pharmacy ustekinumab 130 mg/26 mL [INYO] RXP02150 CDM J3358 HCPCS 57894-0054-27 NDC facility both 26 ML 9600 9600 Gross Charge Type: Pharmacy midazolam 5 mg/mL Sol INTRA NASAL [INYO] RXP02151 CDM J2250 HCPCS 00641-6061-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy midazolam 5 mg/mL Sol RXP02151 CDM J2250 HCPCS 63323-0412-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy ocrelizumab 300 mg/10 mL [INYO] RXP02154 CDM J2350 HCPCS 50242-0150-01 NDC facility both 10 ML 56326.8 56326.8 Gross Charge Type: Pharmacy octreotide 1000 mcg/5 mL INJ [INYO] RXP02155 CDM J2354 HCPCS 63323-0378-05 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy Take Home Clindamycin 150 mg #6 oral Tab [INYO] RXP02157 CDM 68071-2286-06 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Take Home Clindamycin 150 mg #6 oral Tab [INYO] RXP02157 CDM 00904-5959-61-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 CAP CARBOplatin 600 mg/60 mL IV Sol [INYO] RXP02159 CDM J9045 HCPCS 63323-0172-60 NDC facility both 60 ML 845 845 Gross Charge Type: Pharmacy CARBOplatin 600 mg/60 mL IV Sol [INYO] RXP02159 CDM J9045 HCPCS 61703-0339-56 NDC facility both 60 ML 468.3 468.3 Gross Charge Type: Pharmacy CARBOplatin 600 mg/60 mL IV Sol [INYO] RXP02159 CDM J9045 HCPCS 55150-0386-01 NDC facility both 60 ML 421.54 421.54 Gross Charge Type: Pharmacy phenylephrine 10 mg/mL Sol [inyo] RXP02161 CDM J2371 HCPCS 70069-0801-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy phenylephrine 10 mg/mL Inj Sol [INYO] RXP02161 CDM J2371 HCPCS 55150-0300-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy phenylephrine 10 mg/mL Inj Sol [INYO] RXP02161 CDM J2371 HCPCS 70121-1577-05 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy phenylephrine 10 mg/mL Inj Sol [INYO] RXP02161 CDM J2371 HCPCS 71288-0807-02 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy phenylephrine 10 mg/mL Inj Sol [INYO] RXP02161 CDM J2371 HCPCS 00641-6142-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy ciprofloxacin Ophth 0.3% Sol [INYO] RXP02164 CDM 69315-0308-02 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS ciprofloxacin Ophth 0.3% Sol [INYO] RXP02164 CDM 61314-0656-10 NDC facility both 1 EA 377.76 377.76 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS Amino Acids 5% with 15% Dextrose and Electrolytes (Clinimix E) IV Sol 1000 mL [INYO] RXP02166 CDM 00338-1147-03 NDC facility both 1000 ML 330 330 Gross Charge Type: Pharmacy acetaZOLAMIDE 500 mg Pow [INYO] RXP02167 CDM J1120 HCPCS 00143-9503-01 NDC facility both 1 EA 422 422 Gross Charge Type: Pharmacy acetaZOLAMIDE 500 mg Pow [INYO] RXP02167 CDM J1120 HCPCS 39822-0190-01 NDC facility both 1 EA 315.04 315.04 Gross Charge Type: Pharmacy pregabalin 100 mg oral capsule [INYO] RXP02168 CDM 00904-7001-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP pregabalin 100 mg oral capsule [INYO] RXP02168 CDM 00071-1015-68 NDC facility both 1 EA 49.11 49.11 Gross Charge Type: Pharmacy | NDC EA = 1 CAP meperidine 50 mg/mL Inj Sol [INYO] RXP02169 CDM J2175 HCPCS 00409-1178-30 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy meperidine 50 mg/mL Sol RXP02169 CDM J2175 HCPCS 00409-1418-01 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy ferric carboxymaltose (as elemental iron) 50 mg/mL [INYO] RXP02171 CDM J1439 HCPCS 00517-0650-01 NDC facility both 15 ML 5205.2 5205.2 Gross Charge Type: Pharmacy DOCEtaxel 20 mg/mL [INYO] RXP02174 CDM J9171 HCPCS 39822-2200-01 NDC facility both 20 ML 8400 8400 Gross Charge Type: Pharmacy "naltrexone 380 mg IM Inj, ER [INYO]" RXP02177 CDM J2315 HCPCS 65757-0300-01 NDC facility both 1 EA 7877.32 7877.32 Gross Charge Type: Pharmacy morphine 4 mg/mL preservative-free [INYO] RXP02179 CDM J2270 HCPCS 00641-6125-25 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy bevacizumab 400 mg/16mL IV Sol [INYO] RXP02182 CDM J9035 HCPCS 50242-0061-01 NDC facility both 16 ML 15301.25 15301.25 Gross Charge Type: Pharmacy nafcillin 1 g Inj [INYO] RXP02185 CDM 44567-0221-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy nafcillin 1 g Pow [INYO] RXP02185 CDM 55150-0122-15 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ertapenem 1 g Pow [inyo] RXP02187 CDM J1335 HCPCS 44567-0820-10 NDC facility both 1 EA 1520 1520 Gross Charge Type: Pharmacy ertapenem 1 g Inj [INYO] RXP02187 CDM J1335 HCPCS 60505-6196-04 NDC facility both 1 EA 1123.87 1123.87 Gross Charge Type: Pharmacy ertapenem 1 g Inj [INYO] RXP02187 CDM J1335 HCPCS 00006-3843-71 NDC facility both 1 EA 1520 1520 Gross Charge Type: Pharmacy clindamycin 2% Vag Crm [INYO] RXP02188 CDM 00168-0277-40 NDC facility both 1 EA 521.28 521.28 Gross Charge Type: Pharmacy | NDC EA = 40 APP insulin lispro 100 units/mL [INYO] RXP02191 CDM J1815 HCPCS 00024-5926-05 NDC facility both 3 ML 376.64 376.64 Gross Charge Type: Pharmacy insulin lispro 100 units/mL [INYO] RXP02191 CDM J1815 HCPCS 00002-7533-01 NDC facility both 3 ML 791.12 791.12 Gross Charge Type: Pharmacy insulin lispro 100 units/mL [INYO] RXP02191 CDM J1815 HCPCS 00002-7510-17 NDC facility both 3 ML 791.12 791.12 Gross Charge Type: Pharmacy insulin regular human recombinant 100 units/mL Sol [INYO] RXP02192 CDM J1815 HCPCS 00002-0213-01 NDC facility both 3 ML 428.24 428.24 Gross Charge Type: Pharmacy insulin regular human recombinant 100 units/mL Inj Sol [INYO] RXP02192 CDM J1815 HCPCS 00002-8215-17 NDC facility both 3 ML 428.24 428.24 Gross Charge Type: Pharmacy hydroxyprogesterone 250 mg/mL IM Sol [INYO] RXP02196 CDM J1729 HCPCS 64011-0247-02 NDC facility both 1 ML 4020 4020 Gross Charge Type: Pharmacy nafcillin 2 g Inj [INYO] RXP02197 CDM 44567-0222-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy nafcillin 2 g Pow RXP02197 CDM 63323-0328-20 NDC facility both 1 EA 277.34 277.34 Gross Charge Type: Pharmacy nafcillin 2 g Inj [INYO] RXP02197 CDM 55150-0123-15 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy aprepitant 40 mg oral capsule [INYO] RXP02198 CDM J8501 HCPCS 00781-2321-06 NDC facility both 1 EA 439.76 439.76 Gross Charge Type: Pharmacy | NDC EA = 1 CAP aprepitant 40 mg Cap RXP02198 CDM J8501 HCPCS 13668-0591-81 NDC facility both 1 EA 439.76 439.76 Gross Charge Type: Pharmacy | NDC EA = 1 CAP aprepitant 40 mg Cap RXP02198 CDM J8501 HCPCS 68462-0583-40 NDC facility both 1 EA 439.76 439.76 Gross Charge Type: Pharmacy | NDC EA = 1 CAP vancomycin 1 g Pow Inj [INYO] RXP02203 CDM J3370 HCPCS 67457-0340-01 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy vancomycin 1 g IV Inj [INYO] RXP02203 CDM J3370 HCPCS 70860-0105-20 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy vancomycin 1 g IV Inj [INYO] RXP02203 CDM J3370 HCPCS 47781-0597-91 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy vancomycin 1 g IV Inj [INYO] RXP02203 CDM J3370 HCPCS 00409-6533-01 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy nivolumab 10 mg/mL [INYO] RXP02204 CDM J9299 HCPCS 00003-3734-13 NDC facility both 24 ML 19741.35 19741.35 Gross Charge Type: Pharmacy glucose 40% Oral gel [INYO] RXP02205 CDM 00574-0069-15 NDC facility both 15 EA 23.7 23.7 Gross Charge Type: Pharmacy APAP-hydrocodone 217 mg-5 mg/10 mL UD [INYO] RXP02207 CDM 00121-1544-40 NDC facility both 10 ML 49.08 49.08 Gross Charge Type: Pharmacy patiromer 8.4 g Pow [INYO] RXP02209 CDM 53436-0084-04 NDC facility both 1 EA 240 240 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS cefTAZidime 1 g Inj [INYO] RXP02210 CDM J0713 HCPCS 44567-0235-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTAZidime 1 g Inj [INYO] RXP02210 CDM J0713 HCPCS 25021-0127-20 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy naloxone 4 mg/0.1 mL Spr [INYO] RXP02211 CDM 45802-0578-84 NDC facility both 1 EA 384 384 Gross Charge Type: Pharmacy | NDC EA = 1 SPRAYS naloxone 4 mg/0.1 mL Spr [inyo] RXP02211 CDM 69547-0627-02 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy | NDC EA = 1 SPRAYS naloxone 4 mg/0.1 mL Spr [INYO] RXP02211 CDM 45802-0811-84 NDC facility both 1 EA 518.4 518.4 Gross Charge Type: Pharmacy | NDC EA = 1 SPRAYS naloxone 4 mg/0.1 mL Spr [INYO] RXP02211 CDM 69547-0353-02 NDC facility both 1 EA 600 600 Gross Charge Type: Pharmacy | NDC EA = 1 SPRAYS ziprasidone 20 mg IM Inj [INYO] RXP02212 CDM J3486 HCPCS 00049-3920-83 NDC facility both 1 EA 500.3 500.3 Gross Charge Type: Pharmacy ziprasidone 20 mg Pow [inyo] RXP02212 CDM J3486 HCPCS 72266-0160-10 NDC facility both 1 EA 314.78 314.78 Gross Charge Type: Pharmacy fluorescein ophthalmic 1 mg Test [INYO] RXP02213 CDM 17238-0900-11 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 STRIP fluorescein ophthalmic 1 mg Test [INYO] RXP02213 CDM 17478-0404-01 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 STRIP iodine-potassium iodide 5%-10% oral Sol 14 mL [INYO] RXP02214 CDM 48433-0230-15 NDC facility both 14 ML 13.09 13.09 Gross Charge Type: Pharmacy buprenorphine 8 mg Tab [INYO] RXP02215 CDM J0571 HCPCS 00904-7155-04 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buprenorphine 8 mg sublingual Dis Tab [INYO] RXP02215 CDM J0571 HCPCS 60687-0492-21 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buprenorphine 8 mg sublingual Dis Tab [INYO] RXP02215 CDM J0571 HCPCS 00054-0177-13 NDC facility both 1 EA 38.7 38.7 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buprenorphine 7.5 mcg/hr [INYO] RXP02216 CDM 42858-0353-40 NDC facility both 1 EA 450.99 450.99 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES Metoprolol TARTrate 25 mg Tab [INYO] RXP04401 CDM 51079-0255-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Metoprolol TARTrate 25 mg Tab [INYO] RXP04401 CDM 00904-6340-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB QUEtiapine 25 mg Tab [INYO] RXP04404 CDM 00904-6638-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB QUEtiapine 25 mg Tab [INYO] RXP04404 CDM 50268-0630-15 NDC facility both 1 EA 22.28 22.28 Gross Charge Type: Pharmacy | NDC EA = 1 TAB QUEtiapine 25 mg Tab [INYO] RXP04404 CDM 67877-0242-01 NDC facility both 1 EA 24 24 Gross Charge Type: Pharmacy | NDC EA = 1 TAB insulin glargine 100 units/mL SubQ Sol [INYO] RXP04405 CDM J1815 HCPCS 00088-2220-33 NDC facility both 10 ML 616.8 616.8 Gross Charge Type: Pharmacy insulin glargine 100 units/mL SubQ Sol [INYO] RXP04405 CDM J1815 HCPCS 49502-0195-80 NDC facility both 10 ML 947.04 947.04 Gross Charge Type: Pharmacy pantoprazole 40 mg IV inj [INYO] RXP04406 CDM S0164 HCPCS 71288-0600-11 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy pantoprazole 40 mg IV Inj [INYO] RXP04406 CDM S0164 HCPCS 00008-0923-55 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy pantoprazole 40 mg IV Inj [INYO] RXP04406 CDM S0164 HCPCS 55150-0202-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy pantoprazole 40 mg IV Inj [INYO] RXP04406 CDM S0164 HCPCS 00008-2001-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy potassium chloride - Powder-Recon RXP04407 CDM 60219-1617-03 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy potassium chloride 20 mEq Oral Pwdr [INYO] RXP04407 CDM 69238-1617-03 NDC facility both 1 EA 53.7 53.7 Gross Charge Type: Pharmacy potassium chloride 20 mEq Pow [INYO] RXP04407 CDM 00603-1554-16 NDC facility both 1 EA 53.7 53.7 Gross Charge Type: Pharmacy potassium chloride 20 mEq Oral Pwdr [INYO] RXP04407 CDM 00603-1554-04 NDC facility both 1 EA 51.01 51.01 Gross Charge Type: Pharmacy potassium chloride 20 mEq Oral Pwdr [INYO] RXP04407 CDM 69543-0451-30 NDC facility both 1 EA 53.7 53.7 Gross Charge Type: Pharmacy amoxicillin-clavulanate 200 mg-28.5 mg/5 mL Oral Liq 50 mL [INYO] RXP04408 CDM 66685-1011-00 NDC facility both 50 ML 92.25 92.25 Gross Charge Type: Pharmacy fluticasone Nasal 0.05 mg/inh Spry [INYO] RXP04409 CDM 60505-0829-01 NDC facility both 16 EA 127.89 127.89 Gross Charge Type: Pharmacy fluticasone Nasal 0.05 mg/inh Spry [INYO] RXP04409 CDM 00054-3270-99 NDC facility both 16 EA 112.91 112.91 Gross Charge Type: Pharmacy felodipine 10 mg ER Tab [INYO] RXP04410 CDM 68462-0235-01 NDC facility both 1 EA 17.04 17.04 Gross Charge Type: Pharmacy | NDC EA = 1 TAB felodipine 10 mg ER Tab [INYO] RXP04410 CDM 13668-0134-01 NDC facility both 1 EA 16.29 16.29 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tolterodine 2 mg ERCap [INYO] RXP04415 CDM 00093-7163-56 NDC facility both 1 EA 48.21 48.21 Gross Charge Type: Pharmacy | NDC EA = 1 CAP tolterodine 2 mg ERCap [INYO] RXP04415 CDM 00904-6592-04 NDC facility both 1 EA 67.77 67.77 Gross Charge Type: Pharmacy | NDC EA = 1 CAP tolterodine 2 mg ERCap [INYO] RXP04415 CDM 00009-5190-01 NDC facility both 1 EA 73 73 Gross Charge Type: Pharmacy | NDC EA = 1 CAP metoprolol SUCCinate 25 mg ER Tab [INYO] RXP04417 CDM 00904-6322-06 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoprolol SUCCinate 25 mg ER Tab [INYO] RXP04417 CDM 00904-6322-61 NDC facility both 1 EA 7.44 7.44 Gross Charge Type: Pharmacy | NDC EA = 1 TAB metoprolol SUCCinate 25 mg ER Tab [INYO] RXP04417 CDM 00186-1088-39 NDC facility both 1 EA 8.61 8.61 Gross Charge Type: Pharmacy | NDC EA = 1 TAB fentaNYL 100 mcg/hr Fil [INYO] RXP04418 CDM 47781-0428-47 NDC facility both 1 EA 314.85 314.85 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES fentaNYL 100 mcg/hr Transderm ER Film [INYO] RXP04418 CDM 00378-9124-16 NDC facility both 1 EA 280 280 Gross Charge Type: Pharmacy | NDC EA = 1 PATCHES mirtazapine 15 mg Tab [INYO] RXP04419 CDM 00904-6519-61 NDC facility both 1 EA 17.15 17.15 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dronabinol 5 mg Cap [INYO] RXP04422 CDM Q0167 HCPCS 68084-0175-21 NDC facility both 1 EA 61.32 61.32 Gross Charge Type: Pharmacy | NDC EA = 1 CAP droNABinol 5 mg Cap [INYO] RXP04422 CDM Q0167 HCPCS 60687-0386-21 NDC facility both 1 EA 61.32 61.32 Gross Charge Type: Pharmacy | NDC EA = 1 CAP droNABinol 5 mg Cap RXP04422 CDM Q0167 HCPCS 00904-7145-04 NDC facility both 1 EA 57.85 57.85 Gross Charge Type: Pharmacy | NDC EA = 1 CAP amoxicillin-clavulanate 500 mg-125 mg Tab [INYO] RXP04423 CDM 00093-2274-34 NDC facility both 1 EA 22.71 22.71 Gross Charge Type: Pharmacy | NDC EA = 1 TAB amoxicillin-clavulanate 500 mg-125 mg Tab [INYO] RXP04423 CDM 66685-1002-00 NDC facility both 1 EA 22.71 22.71 Gross Charge Type: Pharmacy | NDC EA = 1 TAB magnesium oxide 400 mg Tab UD [INYO] RXP04425 CDM 10006-0700-28 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB meclizine 25 mg Tab [INYO] RXP04426 CDM 60687-0730-65 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB meclizine 25 mg Tab [INYO] RXP04426 CDM 00904-6517-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ursodiol 300 mg Cap [INYO] RXP04430 CDM 00904-6221-06 NDC facility both 1 EA 53.89 53.89 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ursodiol 300 mg Cap [INYO] RXP04430 CDM 00904-7168-06 NDC facility both 1 EA 53.89 53.89 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ursodiol 300 mg Cap [INYO] RXP04430 CDM 00904-7168-61 NDC facility both 1 EA 31.63 31.63 Gross Charge Type: Pharmacy | NDC EA = 1 CAP venlafaxine 37.5 mg ER Cap [INYO] RXP04431 CDM 00904-7075-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP venlafaxine 37.5 mg ERCap [INYO] RXP04431 CDM 00904-6468-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP insulin aspart 100 units/mL [INYO] RXP04432 CDM J1815 HCPCS 00169-7501-11 NDC facility both 10 ML 2083.38 2083.38 Gross Charge Type: Pharmacy insulin aspart 100 units/mL Sol [inyo] RXP04432 CDM J1815 HCPCS 73070-0100-11 NDC facility both 10 ML 694.46 694.46 Gross Charge Type: Pharmacy rOPINIRole 1 mg Tab [INYO] RXP04433 CDM 00904-6374-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rOPINIRole 1 mg Tab [INYO] RXP04433 CDM 00054-0118-25 NDC facility both 1 EA 15.03 15.03 Gross Charge Type: Pharmacy | NDC EA = 1 TAB gentamicin 800 mg/ 20 mL Sol [INYO] RXP04434 CDM J1580 HCPCS 63323-0010-20 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy valproic acid 100 mg/mL [INYO] RXP04436 CDM 63323-0494-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy valproic acid 100 mg/mL [INYO] RXP04436 CDM 00143-9785-10 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy valproic acid 100 mg/mL [INYO] RXP04436 CDM 00074-1564-10 NDC facility both 5 ML 304.48 304.48 Gross Charge Type: Pharmacy carvedilol 25 mg Tab [INYO] RXP04437 CDM 00904-6303-61 NDC facility both 1 EA 12.61 12.61 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carvedilol 25 mg Tab [INYO] RXP04437 CDM 51079-0932-20 NDC facility both 1 EA 12.8 12.8 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carvedilol 3.125 mg Tab [INYO] RXP04438 CDM 00904-6300-61 NDC facility both 1 EA 12.61 12.61 Gross Charge Type: Pharmacy | NDC EA = 1 TAB octreotide 100 mcg/mL Sol [INYO] RXP04439 CDM J2354 HCPCS 68462-0896-10 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy octreotide 100 mcg/mL Inj Sol [INYO] RXP04439 CDM J2354 HCPCS 63323-0376-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy octreotide 100 mcg/mL Sol [inyo] RXP04439 CDM J2354 HCPCS 25021-0464-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy octreotide 100 mcg/mL Inj Sol [INYO] RXP04439 CDM J2354 HCPCS 00641-6175-10 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy octreotide 100 mcg/mL Inj Sol [INYO] RXP04439 CDM J2354 HCPCS 00703-3311-04 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy tolterodine 4 mg ERCap [INYO] RXP04440 CDM 00009-5191-02 NDC facility both 1 EA 73 73 Gross Charge Type: Pharmacy | NDC EA = 1 CAP valACYclovir 1 g Tab [INYO] RXP04441 CDM 00378-4276-93 NDC facility both 1 EA 63.21 63.21 Gross Charge Type: Pharmacy | NDC EA = 1 TAB valACYclovir 1 g Tab [INYO] RXP04441 CDM 50268-0789-15 NDC facility both 1 EA 41.8 41.8 Gross Charge Type: Pharmacy | NDC EA = 1 TAB topiramate 100 mg Tab [INYO] RXP04442 CDM 68382-0140-14 NDC facility both 1 EA 41.78 41.78 Gross Charge Type: Pharmacy | NDC EA = 1 TAB topiramate 100 mg Tab [INYO] RXP04442 CDM 00904-6929-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB topiramate 100 mg Tab [INYO] RXP04442 CDM 68084-0344-01 NDC facility both 1 EA 37.2 37.2 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cilostazol 100 mg Tab [INYO] RXP04444 CDM 50268-0177-15 NDC facility both 1 EA 13.5 13.5 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cilostazol 100 mg Tab [inyo] RXP04444 CDM 60505-2522-01 NDC facility both 1 EA 10.95 10.95 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tolterodine 2 mg Tab [INYO] RXP04446 CDM 16571-0127-06 NDC facility both 1 EA 20.38 20.38 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tolterodine 2 mg Tab [INYO] RXP04446 CDM 00009-4544-02 NDC facility both 1 EA 52.9 52.9 Gross Charge Type: Pharmacy | NDC EA = 1 TAB tolterodine 2 mg Tab [INYO] RXP04446 CDM 00093-0018-06 NDC facility both 1 EA 20.38 20.38 Gross Charge Type: Pharmacy | NDC EA = 1 TAB trastuzumab 150 mg Pow [INYO] RXP04452 CDM J9355 HCPCS 50242-0132-01 NDC facility both 1 EA 9350.49 9350.49 Gross Charge Type: Pharmacy nesiritide 1.5 mg IV Inj [INYO] RXP04453 CDM J2325 HCPCS 65847-0205-25 NDC facility both 1 EA 5080.85 5080.85 Gross Charge Type: Pharmacy trihexyphenidyl 5 mg Tab [INYO] RXP04457 CDM 00591-5337-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB budesonide 0.5 mg/2 mL Inh Susp [INYO] RXP04458 CDM J7633 HCPCS 00093-6816-55 NDC facility both 2 ML 66.47 66.47 Gross Charge Type: Pharmacy budesonide 0.5 mg/2 mL Inh Susp [INYO] RXP04458 CDM J7633 HCPCS 60687-0524-83 NDC facility both 2 ML 67.2 67.2 Gross Charge Type: Pharmacy budesonide 0.5 mg/2 mL Inh Susp [INYO] RXP04458 CDM J7633 HCPCS 00093-6816-73 NDC facility both 2 ML 66.47 66.47 Gross Charge Type: Pharmacy budesonide 0.5 mg/2 mL Inh Susp [INYO] RXP04458 CDM J7633 HCPCS 00487-9701-01 NDC facility both 2 ML 66.99 66.99 Gross Charge Type: Pharmacy levofloxacin 250 mg Tab [INYO] RXP04459 CDM 00904-6351-61 NDC facility both 1 EA 73.63 73.63 Gross Charge Type: Pharmacy | NDC EA = 1 TAB topiramate 25 mg Tab [INYO] RXP04460 CDM 00904-6928-61 NDC facility both 1 EA 12.6 12.6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB topiramate 25 mg Tab [INYO] RXP04460 CDM 68084-0342-01 NDC facility both 1 EA 12.6 12.6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Lorazepam 0.5 mg #4 oral Tab [INYO] RXP04465 CDM 00591-0240-10-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Diazepam 5 mg #4 [INYO] RXP04466 CDM 00904-5880-61-THP NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Diazepam 5 mg #4 [INYO] RXP04466 CDM 68071-2826-04 NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Acet w/ Codeine 30 mg #6 [INYO] RXP04468 CDM 00406-0484-62-THP NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Alprazolam 0.25 mg 4 tab oral Tab [INYO] RXP04469 CDM 68071-2236-04 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Alprazolam 0.25 mg 4 tab oral Tab [INYO] RXP04469 CDM 00904-5858-61-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Promethazine w/ codeine 25 ml #1 oral Liquid [INYO] RXP04470 CDM 00603-1585-58-THP NDC facility both 1 ML 60 60 Gross Charge Type: Pharmacy Sodium Chloride 0.9% with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP04475 CDM J3480 HCPCS 00990-7115-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP04475 CDM J3480 HCPCS 00264-7865-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Take Home Ibuprofen 600 mg #4 [INYO] RXP04477 CDM 00904-5854-61-THP NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Ibuprofen 600 mg #4 [INYO] RXP04477 CDM 68071-2946-04 NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Ibuprofen 400 mg #4 [INYO] RXP04478 CDM 00904-5853-61-THP NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Phenytoin 100 mg #4 oral Cap [INYO] RXP04479 CDM 00904-6187-61-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Take Home Furosemide 40 mg #4 [INYO] RXP04480 CDM 00904-5797-61-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Phenazopyridine 100 mg #4 oral Tab [INYO] RXP04481 CDM 68071-2357-04 NDC facility both 1 EA 87.24 87.24 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Phenazopyridine 100 mg #4 oral Tab [INYO] RXP04481 CDM 75826-0114-10-THP NDC facility both 1 EA 87.24 87.24 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Bactrim DS #3 oral Tab [INYO] RXP04482 CDM 68071-4948-03-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Amoxicillin 250 mg #6 [INYO] RXP04485 CDM 00781-2020-01-THP NDC facility both 1 EA 180 180 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Take Home Cephalexin 500 mg Cap #6 [INYO] RXP04486 CDM 50268-0152-15-THP NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Take Home Cephalexin 500 mg Cap #6 [INYO] RXP04486 CDM 68071-2726-06 NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Take Home Cipro 500 mg Tab #3 [INYO] RXP04487 CDM 00904-6378-61-THP NDC facility both 1 EA 180 180 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Cyclobenzaprine 10 mg #4 [INYO] RXP04488 CDM 68071-2673-04 NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Cyclobenzaprine 10 mg #4 [INYO] RXP04488 CDM 51079-0644-20-THP NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Dicloxacillin 250 mg #4 [INYO] RXP04489 CDM 00093-3123-01-THP NDC facility both 1 EA 30 30 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Take Home Diphenhydramine 25 mg #4 [INYO] RXP04490 CDM 00904-5551-59-THP NDC facility both 1 EA 180 180 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Diphenhydramine 25 mg #4 [INYO] RXP04490 CDM 68071-3465-04 NDC facility both 1 EA 180 180 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Doxycycline Hyclate 100 mg #3 oral Tab [INYO] RXP04491 CDM 68071-4883-03 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 CAP Take Home Doxycycline Hyclate 100 mg #3 oral Tab [INYO] RXP04491 CDM 49884-0727-03-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 CAP HYDROcodone-acetaminophen . Tab RXP04492 CDM 68071-2668-06 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Norco 5/325 mg #6 [INYO] RXP04492 CDM 00406-0123-62-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB escitalopram 10 mg Tab [INYO] RXP04497 CDM 00904-6426-61 NDC facility both 1 EA 26.28 26.28 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Penicillin VK 250 mg #6 oral Tab [INYO] RXP04498 CDM 68071-2457-06 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Take Home Penicillin VK 250 mg #6 oral Tab [INYO] RXP04498 CDM 00781-1205-01-THP NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB capecitabine 150 mg Tab [INYO] RXP04499 CDM J8520 HCPCS 00004-1100-20 NDC facility both 1 EA 81.35 81.35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dexAMETHasone 4 mg/mL Sol RXP04500 CDM J1100 HCPCS 00641-6145-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy dexamethasone 4 mg/mL Inj Sol [INYO] RXP04500 CDM J1100 HCPCS 63323-0165-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy succinylcholine 20 mg/mL Soln [INYO] RXP04501 CDM J0330 HCPCS 70069-0783-25 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy succinylcholine 20 mg/mL Inj Sol [INYO] RXP04501 CDM J0330 HCPCS 70069-0301-25 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy succinylcholine 20 mg/mL Inj Sol [INYO] RXP04501 CDM J0330 HCPCS 00409-6629-02 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy succinylcholine 20 mg/mL Inj Sol [INYO] RXP04501 CDM J0330 HCPCS 14789-0104-05 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy succinylcholine 20 mg/mL Inj Sol [INYO] RXP04501 CDM J0330 HCPCS 54879-0037-25 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy succinylcholine 20 mg/mL Inj Sol [INYO] RXP04501 CDM J0330 HCPCS 63323-0943-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy succinylcholine 20 mg/mL Inj Sol [INYO] RXP04501 CDM J0330 HCPCS 70710-1377-02 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy succinylcholine 20 mg/mL Inj Sol [INYO] RXP04501 CDM J0330 HCPCS 69918-0700-25 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy albuterol-ipratropium Inh Sol 3 mL [INYO] RXP04504 CDM J7620 HCPCS 00378-9671-93 NDC facility both 3 ML 36 36 Gross Charge Type: Pharmacy albuterol-ipratropium Inh Sol 3 mL [INYO] RXP04504 CDM J7620 HCPCS 60687-0405-83 NDC facility both 3 ML 36 36 Gross Charge Type: Pharmacy albuterol-ipratropium Inh Sol 3 mL [INYO] RXP04504 CDM J7620 HCPCS 00487-0201-01 NDC facility both 3 ML 36 36 Gross Charge Type: Pharmacy albuterol-ipratropium Inh Sol 3 mL [INYO] RXP04504 CDM J7620 HCPCS 69097-0840-87 NDC facility both 3 ML 36 36 Gross Charge Type: Pharmacy albuterol-ipratropium Inh Sol 3 mL [INYO] RXP04504 CDM J7620 HCPCS 69097-0840-53 NDC facility both 3 ML 36 36 Gross Charge Type: Pharmacy heparin 5000 units/mL Inj Sol [INYO] RXP04512 CDM J1644 HCPCS 63323-0262-06 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy heparin 5000 units/mL Inj Sol [INYO] RXP04512 CDM J1644 HCPCS 25021-0402-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy heparin 5000 units/mL Inj Sol [INYO] RXP04512 CDM J1644 HCPCS 63323-0262-36 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy heparin 5000 units/mL Inj Sol [INYO] RXP04512 CDM J1644 HCPCS 00641-0400-12 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy heparin 5000 units/mL Inj Sol [INYO] RXP04512 CDM J1644 HCPCS 71288-0403-02 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy heparin 5000 units/mL Inj Sol [INYO] RXP04512 CDM J1644 HCPCS 00409-2723-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy levofloxacin 250 mg/50 mL IV Sol [INYO] RXP04519 CDM J1956 HCPCS 00781-3341-09 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy fludrocortisone 0.1 mg Tab [INYO] RXP04528 CDM 50268-0330-15 NDC facility both 1 EA 9.59 9.59 Gross Charge Type: Pharmacy | NDC EA = 1 TAB fentaNYL 1000 mcg/100mL-NaCl 0.9% PCA [INYO] RXP04532 CDM J3010 HCPCS 70092-1092-36 NDC facility both 100 ML 204.96 204.96 Gross Charge Type: Pharmacy antivenin (Crotalidae) polyvalent - Pow [INYO] RXP04533 CDM J0840 HCPCS 50633-0110-12 NDC facility both 1 EA 10020 10020 Gross Charge Type: Pharmacy | NDC EA = 1 VIALS racepinephrine 2.25% UD [INYO] RXP04534 CDM 00487-5901-99 NDC facility both 1 ML 36 36 Gross Charge Type: Pharmacy "epoetin alfa 40,000 units/mL preservative-free [INYO]" RXP04536 CDM J0885 HCPCS 59676-0340-01 NDC facility both 1 ML 5131.2 5131.2 Gross Charge Type: Pharmacy oxaliplatin 100mg/20mL IV Sol [INYO] RXP04538 CDM J9263 HCPCS 16729-0332-05 NDC facility both 20 ML 2121.9 2121.9 Gross Charge Type: Pharmacy oxaliplatin 100mg/20mL IV Sol [INYO] RXP04538 CDM J9263 HCPCS 25021-0233-20 NDC facility both 20 ML 845 845 Gross Charge Type: Pharmacy polyethylene glycol 3350 Oral Pwdr for Recon 17g [INYO] RXP04539 CDM 00904-6931-26 NDC facility both 1 EA 11.21 11.21 Gross Charge Type: Pharmacy polyethylene glycol 3350 Oral Pwdr for Recon 17g [INYO] RXP04539 CDM 68084-0430-98 NDC facility both 1 EA 16.7 16.7 Gross Charge Type: Pharmacy polyethylene glycol 3350 Oral Pwdr for Recon 17g [INYO] RXP04539 CDM 45802-0868-66 NDC facility both 1 EA 14.79 14.79 Gross Charge Type: Pharmacy naloxone 1 mg/mL Inj Sol [INYO] RXP04543 CDM J2310 HCPCS 76329-3369-01 NDC facility both 2 ML 316.8 316.8 Gross Charge Type: Pharmacy naloxone 1 mg/mL Sol [inyo] RXP04543 CDM J2310 HCPCS 55150-0345-10 NDC facility both 2 ML 302.4 302.4 Gross Charge Type: Pharmacy thrombin topical bovine 5000 intl units Pow [INYO] RXP04549 CDM 60793-0215-05 NDC facility both 1 EA 344.48 344.48 Gross Charge Type: Pharmacy fulvestrant 250 mg/5mL Inj [INYO] RXP04554 CDM J9395 HCPCS 43598-0262-02 NDC facility both 5 ML 845 845 Gross Charge Type: Pharmacy fulvestrant 50 mg/mL Sol [INYO] RXP04554 CDM J9395 HCPCS 70700-0284-98 NDC facility both 5 ML 5453.63 5453.63 Gross Charge Type: Pharmacy fulvestrant 250 mg/5mL IM Inj [INYO] RXP04554 CDM J9395 HCPCS 00143-9022-02 NDC facility both 5 ML 1170 1170 Gross Charge Type: Pharmacy fulvestrant 250 mg/5mL IM Inj [INYO] RXP04554 CDM J9395 HCPCS 71288-0555-86 NDC facility both 5 ML 1170 1170 Gross Charge Type: Pharmacy fulvestrant 250 mg/5mL IM Inj [INYO] RXP04554 CDM J9395 HCPCS 00591-5019-02 NDC facility both 5 ML 5235.48 5235.48 Gross Charge Type: Pharmacy fulvestrant 250 mg/5mL IM Inj [INYO] RXP04554 CDM J9395 HCPCS 00310-0720-10 NDC facility both 5 ML 5817.15 5817.15 Gross Charge Type: Pharmacy temazepam 7.5 mg Cap [INYO] RXP04558 CDM 00406-9960-01 NDC facility both 1 EA 49.7 49.7 Gross Charge Type: Pharmacy | NDC EA = 1 CAP temazepam 7.5 mg Cap [INYO] RXP04558 CDM 00904-6436-04 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 CAP lidocaine topical 4% Kit [INYO] RXP04561 CDM 24357-0701-07 NDC facility both 1 EA 165 165 Gross Charge Type: Pharmacy | NDC EA = 1 APP lidocaine topical 4% Kit [INYO] RXP04561 CDM 00496-0882-07 NDC facility both 1 EA 240.35 240.35 Gross Charge Type: Pharmacy | NDC EA = 1 APP levofloxacin 500 mg/100 mL Sol [INYO] RXP04563 CDM J1956 HCPCS 00143-9721-24 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy levofloxacin 500 mg/100 mL IV Sol [INYO] RXP04563 CDM J1956 HCPCS 36000-0047-24 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy levofloxacin 500 mg/100 mL IV Sol [INYO] RXP04563 CDM J1956 HCPCS 44567-0436-24 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy levofloxacin 500 mg/100 mL IV Sol [INYO] RXP04563 CDM J1956 HCPCS 00781-3342-09 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy EPINEPHrine 1 mg/mL Inj 30 mL Sol [INYO] RXP04564 CDM J0171 HCPCS 42023-0168-01 NDC facility both 30 ML 1804.1 1804.1 Gross Charge Type: Pharmacy EPINEPHrine 1 mg/mL Inj 30 mL Sol [INYO] RXP04564 CDM J0171 HCPCS 76329-9060-00 NDC facility both 30 ML 1620 1620 Gross Charge Type: Pharmacy ketoconazole Top 2% Crm [INYO] RXP04566 CDM 51672-1298-01 NDC facility both 1 EA 43.78 43.78 Gross Charge Type: Pharmacy | NDC EA = 15 APP ketoconazole Top 2% Crm [INYO] RXP04566 CDM 00168-0099-15 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 15 APP levETIRAcetam 500 mg Tab [INYO] RXP04567 CDM 00904-7124-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levETIRAcetam 500 mg Tab [INYO] RXP04567 CDM 68084-0870-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levETIRAcetam 500 mg Tab [INYO] RXP04567 CDM 00904-6052-61 NDC facility both 1 EA 18.98 18.98 Gross Charge Type: Pharmacy | NDC EA = 1 TAB dicyclomine 10 mg/mL Inj Sol [INYO] RXP04569 CDM J0500 HCPCS 58914-0080-52 NDC facility both 2 ML 806.96 806.96 Gross Charge Type: Pharmacy dicyclomine 10 mg/mL Sol RXP04569 CDM J0500 HCPCS 70436-0147-81 NDC facility both 2 ML 374.4 374.4 Gross Charge Type: Pharmacy dicyclomine 10 mg/mL Inj Sol [INYO] RXP04569 CDM J0500 HCPCS 17478-0015-02 NDC facility both 2 ML 726.27 726.27 Gross Charge Type: Pharmacy methylPREDNISolone sodium succinate 1 g Inj [INYO] RXP04763 CDM J2930 HCPCS 00009-0698-01 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy methylPREDNISolone sodium succinate 1 g Inj [INYO] RXP04763 CDM J2930 HCPCS 63323-0265-30 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy phenytoin 50 mg/mL 5 mL Sol [INYO] RXP04764 CDM J1165 HCPCS 00641-2555-45 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy phenytoin 50 mg/mL Inj Sol [INYO] RXP04765 CDM J1165 HCPCS 00641-0493-21 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy phenytoin 50 mg/mL Inj Sol [INYO] RXP04765 CDM J1165 HCPCS 00641-0493-25 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy cathflo 2 mg IV Inj [INYO] RXP04779 CDM J2997 HCPCS 50242-0041-64 NDC facility both 1 EA 1520 1520 Gross Charge Type: Pharmacy "epoetin alfa 20,000 units/2mL Inj Sol [INYO]" RXP04882 CDM J0885 HCPCS 59676-0312-04 NDC facility both 2 ML 4020 4020 Gross Charge Type: Pharmacy epoetin alfa 3000 units/mL preservative-free [INYO] RXP04884 CDM J0885 HCPCS 59676-0303-01 NDC facility both 1 ML 769.73 769.73 Gross Charge Type: Pharmacy dexamethasone 10 mg/mL Inj Sol [INYO] RXP04885 CDM J1100 HCPCS 00641-0367-25 NDC facility both 1 ML 330 330 Gross Charge Type: Pharmacy QUEtiapine 100 mg Tab [inyo] RXP04889 CDM 50268-0632-15 NDC facility both 1 EA 38.75 38.75 Gross Charge Type: Pharmacy | NDC EA = 1 TAB QUEtiapine 100 mg Tab [INYO] RXP04889 CDM 00904-6640-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB venlafaxine 75 mg Cap [inyo] RXP04890 CDM 00904-7077-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP venlafaxine 75 mg ERCap [INYO] RXP04890 CDM 00904-6469-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP OLANZapine 5 mg Tab [INYO] RXP04891 CDM 00904-6377-61 NDC facility both 1 EA 66.08 66.08 Gross Charge Type: Pharmacy | NDC EA = 1 TAB valsartan 80 mg Tab [INYO] RXP04895 CDM 60687-0623-01 NDC facility both 1 EA 7.73 7.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB valsartan 80 mg Tab [INYO] RXP04895 CDM 60687-0128-01 NDC facility both 1 EA 27.89 27.89 Gross Charge Type: Pharmacy | NDC EA = 1 TAB valsartan 80 mg Tab [INYO] RXP04895 CDM 00378-5813-77 NDC facility both 1 EA 29.09 29.09 Gross Charge Type: Pharmacy | NDC EA = 1 TAB misoprostol 200 mcg Tab [INYO] RXP04898 CDM 70954-0444-10 NDC facility both 1 EA 8.58 8.58 Gross Charge Type: Pharmacy | NDC EA = 1 TAB miSOPROStol 200 mcg Tab [inyo] RXP04898 CDM 60687-0746-01 NDC facility both 1 EA 16.35 16.35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB misoprostol 200 mcg Tab [INYO] RXP04898 CDM 68084-0041-01 NDC facility both 1 EA 16.35 16.35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB misoprostol 200 mcg Tab [INYO] RXP04898 CDM 59762-5008-02 NDC facility both 1 EA 7.2 7.2 Gross Charge Type: Pharmacy | NDC EA = 1 TAB misoprostol 200 mcg Tab [INYO] RXP04898 CDM 59762-5008-01 NDC facility both 1 EA 7.2 7.2 Gross Charge Type: Pharmacy | NDC EA = 1 TAB oxyCODONE 40 mg ER Tab [INYO] RXP04899 CDM 59011-0440-10 NDC facility both 1 EA 80.98 80.98 Gross Charge Type: Pharmacy | NDC EA = 1 TAB carvedilol 12.5 mg Tab [INYO] RXP04905 CDM 00904-6302-61 NDC facility both 1 EA 12.61 12.61 Gross Charge Type: Pharmacy | NDC EA = 1 TAB rizatriptan 10 mg Tab [INYO] RXP04908 CDM 00093-7472-43 NDC facility both 1 EA 166.26 166.26 Gross Charge Type: Pharmacy | NDC EA = 1 TAB betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL [INYO] RXP04915 CDM J0702 HCPCS 00517-0720-01 NDC facility both 5 ML 494.4 494.4 Gross Charge Type: Pharmacy betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL [INYO] RXP04915 CDM J0702 HCPCS 00085-4320-01 NDC facility both 5 ML 359.04 359.04 Gross Charge Type: Pharmacy betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL [INYO] RXP04915 CDM J0702 HCPCS 51754-5060-01 NDC facility both 5 ML 384 384 Gross Charge Type: Pharmacy cefOXitin 2 g Pow [inyo] RXP04918 CDM J0694 HCPCS 25021-0110-20 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefOXitin 2 g Pow [INYO] RXP04918 CDM J0694 HCPCS 44567-0246-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefOXitin 2 g Pow [INYO] RXP04918 CDM J0694 HCPCS 00143-9877-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefOXitin 2 g Pow [INYO] RXP04918 CDM J0694 HCPCS 63323-0342-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy bevacizumab 100 mg/4 mL Sol [INYO] RXP04920 CDM J9035 HCPCS 50242-0060-01 NDC facility both 4 ML 4781.64 4781.64 Gross Charge Type: Pharmacy "leuprolide 11.25 mg/3 months IM Inj, ER [INYO]" RXP04921 CDM J1950 HCPCS 00074-3663-03 NDC facility both 1 EA 15200 15200 Gross Charge Type: Pharmacy polymyxin B-trimethoprim Ophth Sol [INYO] RXP04990 CDM 24208-0315-10 NDC facility both 1 EA 80.64 80.64 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS polymyxin B-trimethoprim ophthalmic 10000 units-1 mg/mL Sol[inyo] RXP04990 CDM 61314-0628-10 NDC facility both 1 EA 104.52 104.52 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS polymyxin B-trimethoprim Ophth Sol [INYO] RXP04990 CDM 60758-0908-10 NDC facility both 1 EA 78.42 78.42 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS papaverine 30 mg/mL Inj Sol [INYO] RXP04991 CDM J2440 HCPCS 00517-4010-01 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy pantoprazole 40 mg Oral EC Tab [INYO] RXP05002 CDM 00904-6474-61 NDC facility both 1 EA 24.52 24.52 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pantoprazole 40 mg Oral EC Tab [INYO] RXP05002 CDM 51079-0051-20 NDC facility both 1 EA 31.6 31.6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen-hydrocodone 325 mg-10 mg Tab [NIHD] RXP05004 CDM 60687-0418-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen-hydrocodone 325 mg-10 mg Tab [NIHD] RXP05004 CDM 27808-0037-01 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen-hydrocodone 325 mg-10 mg Tab UD [INYO] RXP05004 CDM 00406-0125-62 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB acetaminophen-hydrocodone 325 mg-10 mg Tab UD [INYO] RXP05004 CDM 00904-6421-61 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "polymyxin B sulfate 500,000 units Inj [INYO]" RXP05010 CDM 72266-0249-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy "polymyxin B sulfate 500,000 units Inj [INYO]" RXP05010 CDM 55150-0234-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy "polymyxin B sulfate 500,000 units Inj [INYO]" RXP05010 CDM 39822-0170-01 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy "polymyxin B sulfate 500,000 units Inj [INYO]" RXP05010 CDM 70860-0103-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy PACLitaxel 300 mg/50 mL Sol [INYO] RXP05012 CDM J9267 HCPCS 00703-3218-01 NDC facility both 50 ML 845 845 Gross Charge Type: Pharmacy PACLitaxel 6 mg/mL Sol [inyo] RXP05012 CDM J9267 HCPCS 70860-0200-50 NDC facility both 50 ML 849.6 849.6 Gross Charge Type: Pharmacy PACLitaxel 300 mg/50 mL Sol [INYO] RXP05012 CDM J9267 HCPCS 61703-0342-50 NDC facility both 50 ML 541.8 541.8 Gross Charge Type: Pharmacy PACLitaxel 300 mg/50 mL Sol [INYO] RXP05012 CDM J9267 HCPCS 45963-0613-59 NDC facility both 50 ML 845 845 Gross Charge Type: Pharmacy pegfilgrastim 6 mg/0.6 mL SubQ Inj [INYO] RXP05013 CDM J2505 HCPCS 55513-0190-01 NDC facility both 0.6 ML 11552.39 11552.39 Gross Charge Type: Pharmacy PEMEtrexed 500 mg IV Inj [INYO] RXP05016 CDM J9305 HCPCS 00002-7623-01 NDC facility both 1 EA 17491.92 17491.92 Gross Charge Type: Pharmacy budesonide 90 mcg/inh Inh Pwdr [INYO] RXP05017 CDM 00186-0917-06 NDC facility both 1 EA 847.36 847.36 Gross Charge Type: Pharmacy | NDC EA = 1 INH calcitriol 0.25 mcg Oral Cap [INYO] RXP05018 CDM 60687-0345-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP calcitriol 0.25 mcg Oral Cap [INYO] RXP05018 CDM 23155-0118-03 NDC facility both 1 EA 7.68 7.68 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ARIPiprazole 10 mg Tab [INYO] RXP05019 CDM 00904-6511-06 NDC facility both 1 EA 50.22 50.22 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ARIPiprazole 10 mg Tab [INYO] RXP05019 CDM 50268-0089-15 NDC facility both 1 EA 149.63 149.63 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ARIPiprazole 10 mg Tab [INYO] RXP05019 CDM 65162-0898-03 NDC facility both 1 EA 160.38 160.38 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "ergocalciferol Vitamin D2 50,000 intl units Cap [INYO]" RXP05022 CDM 60687-0500-01 NDC facility both 1 EA 11.52 11.52 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "ergocalciferol Vitamin D2 50,000 intl units Cap [INYO]" RXP05022 CDM 64380-0737-06 NDC facility both 1 EA 11.83 11.83 Gross Charge Type: Pharmacy | NDC EA = 1 CAP sitaGLIPtin 50 mg oral tablet [INYO] RXP05024 CDM 00006-0112-31 NDC facility both 1 EA 99.36 99.36 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sitaGLIPtin 50 mg oral tablet [INYO] RXP05024 CDM 00006-0112-54 NDC facility both 1 EA 94.68 94.68 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ramipril 1.25 mg Cap [INYO] RXP05025 CDM 61570-0110-01 NDC facility both 1 EA 36.38 36.38 Gross Charge Type: Pharmacy | NDC EA = 1 CAP levothyroxine 175 mcg (0.175 mg) Tab [INYO] RXP05028 CDM 00904-6957-61 NDC facility both 1 EA 6.06 6.06 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levothyroxine 175 mcg (0.175 mg) Tab [INYO] RXP05028 CDM 42292-0040-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levETIRAcetam 750 mg Tab [INYO] RXP05029 CDM 00904-7125-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB levETIRAcetam 750 mg Tab [INYO] RXP05029 CDM 00904-6053-61 NDC facility both 1 EA 25.71 25.71 Gross Charge Type: Pharmacy | NDC EA = 1 TAB epinephrine/lidocaine/tetracaine topical 0.05%-4%-0.5% Gel [INYO] RXP05030 CDM 70092-1612-43 NDC facility both 1.5 ML 15 15 Gross Charge Type: Pharmacy L.E.T. 0.05%-4%-0.5% Gel [INYO] RXP05030 CDM 70092-1137-43 NDC facility both 1.5 ML 80.1 80.1 Gross Charge Type: Pharmacy COQ10 50 MG GUMMIES [INYO] RXP05037 CDM 31604-0028-96 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB THERA TEARS 0.25% EYE DROPS [INYO] RXP05045 CDM 58790-0001-15 NDC facility both 1 EA 50.82 50.82 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS loxapine 5 mg Oral Cap [INYO] RXP05046 CDM 00378-7005-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP zidovudine 50 mg/5 mL Oral Syrup [INYO] RXP05050 CDM 65862-0048-24 NDC facility both 240 ML 260 260 Gross Charge Type: Pharmacy zidovudine 50 mg/5 mL Oral Syrup [INYO] RXP05050 CDM 42799-0404-01 NDC facility both 240 ML 260 260 Gross Charge Type: Pharmacy natalizumab 300 mg/15 mL IV Conc [INYO] RXP05052 CDM J2323 HCPCS 64406-0008-01 NDC facility both 15 ML 15200 15200 Gross Charge Type: Pharmacy Sodium Chloride 0.9% IV Sol 100 mL [INYO] RXP05054 CDM J7040 HCPCS 00264-1800-32 NDC facility both 100 ML 235 235 Gross Charge Type: Pharmacy risperiDONE 0.25 mg Tab [INYO] RXP05063 CDM 00904-6357-61 NDC facility both 1 EA 21.49 21.49 Gross Charge Type: Pharmacy | NDC EA = 1 TAB risperiDONE 0.25 mg Tab [INYO] RXP05063 CDM 50458-0590-10 NDC facility both 1 EA 12.11 12.11 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sincalide 5 mcg Pow [INYO] RXP05492 CDM J2805 HCPCS 00270-0556-15 NDC facility both 1 EA 971.23 971.23 Gross Charge Type: Pharmacy rivastigmine 1.5 mg Cap [INYO] RXP05495 CDM 65862-0648-60 NDC facility both 1 EA 27.97 27.97 Gross Charge Type: Pharmacy | NDC EA = 1 CAP rivastigmine 1.5 mg Cap [INYO] RXP05495 CDM 00904-7107-61 NDC facility both 1 EA 23.65 23.65 Gross Charge Type: Pharmacy | NDC EA = 1 CAP rivastigmine 1.5 mg Cap [INYO] RXP05495 CDM 00904-6587-61 NDC facility both 1 EA 25.13 25.13 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ampicillin 2 g Inj [INYO] RXP05496 CDM J0290 HCPCS 55150-0114-20 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy ampicillin 2 g Inj [INYO] RXP05496 CDM J0290 HCPCS 67457-0352-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTRIAXone 2 g Inj [INYO] RXP05505 CDM J0696 HCPCS 60505-6149-04 NDC facility both 1 EA 730.46 730.46 Gross Charge Type: Pharmacy cefTRIAXone 2 g Inj [INYO] RXP05505 CDM J0696 HCPCS 44567-0702-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTRIAXone 2 g Inj [INYO] RXP05505 CDM J0696 HCPCS 70594-0097-02 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTRIAXone 2 g Inj [INYO] RXP05505 CDM J0696 HCPCS 00143-9856-25 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTRIAXone 2 g Inj [INYO] RXP05505 CDM J0696 HCPCS 00781-3209-95 NDC facility both 1 EA 731.27 731.27 Gross Charge Type: Pharmacy cefTRIAXone 2 g Inj [INYO] RXP05505 CDM J0696 HCPCS 25021-0107-20 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy onabotulinumtoxinA 100 units Pow [INYO] RXP05506 CDM J0585 HCPCS 00023-1145-01 NDC facility both 1 EA 4020 4020 Gross Charge Type: Pharmacy ferric subsulfate Top Sol [INYO] RXP05507 CDM 59365-6065-00 NDC facility both 1 EA 58.95 58.95 Gross Charge Type: Pharmacy | NDC EA = 8 APP isosulfan blue 10 mg/mL Inj Sol [INYO] RXP05511 CDM 67457-0220-05 NDC facility both 5 ML 4245.25 4245.25 Gross Charge Type: Pharmacy isoniazid 300 mg Tab [INYO] RXP05512 CDM 60687-0158-11 NDC facility both 1 EA 6.99 6.99 Gross Charge Type: Pharmacy | NDC EA = 1 TAB isoniazid 300 mg Tab [INYO] RXP05512 CDM 60687-0553-01 NDC facility both 1 EA 7.92 7.92 Gross Charge Type: Pharmacy | NDC EA = 1 TAB isoniazid 300 mg Tab [INYO] RXP05512 CDM 51079-0083-20 NDC facility both 1 EA 7.73 7.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ethambutol 400 mg Tab [INYO] RXP05513 CDM 68850-0012-02 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ethambutol 400 mg Tab [INYO] RXP05513 CDM 68180-0281-01 NDC facility both 1 EA 10.72 10.72 Gross Charge Type: Pharmacy | NDC EA = 1 TAB testosterone undecanoate 750 mg/ 3 mL Sol [INYO] RXP1001 CDM J3145 HCPCS 67979-0511-43 NDC facility both 3 ML 10020 10020 Gross Charge Type: Pharmacy ketamine 10 mg/mL Sol RXP12155 CDM 25021-0682-20 NDC facility both 20 ML 232.8 232.8 Gross Charge Type: Pharmacy ketamine 200 mg/20 mL Inj Sol [INYO] RXP12155 CDM 55150-0438-10 NDC facility both 20 ML 193.03 193.03 Gross Charge Type: Pharmacy ketamine 200 mg/20 mL Inj Sol [INYO] RXP12155 CDM 42023-0113-10 NDC facility both 20 ML 189.9 189.9 Gross Charge Type: Pharmacy ketamine 200 mg/20 mL Inj Sol [INYO] RXP12155 CDM 67457-0181-20 NDC facility both 20 ML 193.03 193.03 Gross Charge Type: Pharmacy cefOXitin 1 g PB [INYO] RXP12156 CDM J0694 HCPCS 00264-3123-11 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy phenylephrine 100 mcg/mL-NaCl 0.9% [INYO] RXP12158 CDM J2371 HCPCS 70092-1046-46 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy belladonna-opium 16.2 mg-30 mg Supp [INYO] RXP12159 CDM 00574-7045-12 NDC facility both 1 EA 137.59 137.59 Gross Charge Type: Pharmacy | NDC EA = 1 SUPP factor IX complex human IV Inj [INYO] RXP12405 CDM J7194 HCPCS 68516-3202-02 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy omalizumab 150 mg SubQ Inj [INYO] RXP12407 CDM J2357 HCPCS 50242-0040-62 NDC facility both 1 EA 6638.15 6638.15 Gross Charge Type: Pharmacy propofol 1000 mg/100 mL [INYO] RXP12412 CDM J2704 HCPCS 63323-0269-65 NDC facility both 100 ML 300 300 Gross Charge Type: Pharmacy propofol 1000 mg/100mL [INYO] RXP12412 CDM J2704 HCPCS 63323-0269-78 NDC facility both 100 ML 300 300 Gross Charge Type: Pharmacy propofol 1000 mg/100 mL [INYO] RXP12412 CDM J2704 HCPCS 00409-4699-24 NDC facility both 100 ML 235 235 Gross Charge Type: Pharmacy propofol 1000 mg/100 mL [INYO] RXP12412 CDM J2704 HCPCS 25021-0608-51 NDC facility both 100 ML 268.8 268.8 Gross Charge Type: Pharmacy cabazitaxel 60 mg/1.5 mL [INYO] RXP12416 CDM J9043 HCPCS 00024-5824-11 NDC facility both 1.5 ML 34012.33 34012.33 Gross Charge Type: Pharmacy levETIRAcetam 100 mg/mL Oral Sol [INYO] RXP12417 CDM 50383-0241-16 NDC facility both 473 ML 288 288 Gross Charge Type: Pharmacy levETIRAcetam 100 mg/mL Oral Sol [INYO] RXP12417 CDM 51991-0651-16 NDC facility both 473 ML 1378.36 1378.36 Gross Charge Type: Pharmacy ramucirumab 10 mg/mL [INYO] RXP12418 CDM J9308 HCPCS 00002-7669-01 NDC facility both 10 ML 6930 6930 Gross Charge Type: Pharmacy ramucirumab 10 mg/mL 50 mL Sol [INYO] RXP12419 CDM J9308 HCPCS 00002-7678-01 NDC facility both 50 ML 18112.5 18112.5 Gross Charge Type: Pharmacy nevirapine 50 mg/5 mL Oral Susp [INYO] RXP12421 CDM 00597-0047-24 NDC facility both 240 ML 941.92 941.92 Gross Charge Type: Pharmacy nevirapine 50 mg/5 mL Oral Susp [INYO] RXP12421 CDM 65862-0057-24 NDC facility both 240 ML 757.12 757.12 Gross Charge Type: Pharmacy cisatracurium 2 mg/mL IV Sol [INYO] RXP12422 CDM 63323-0417-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy ceFAZolin 2 g IVPB [INYO] RXP12423 CDM J0690 HCPCS 00264-3105-11 NDC facility both 1 ML 265 265 Gross Charge Type: Pharmacy levonorgestrel 19.5 mg [INYO] RXP12424 CDM J7296 HCPCS 50419-0424-01 NDC facility both 1 EA 4160.8 4160.8 Gross Charge Type: Pharmacy amoxicillin-clavulanate 400 mg-57 mg/5 mL Oral Liq 50 mL [INYO] RXP12427 CDM 65862-0534-50 NDC facility both 50 ML 175.75 175.75 Gross Charge Type: Pharmacy amoxicillin-clavulanate 400 mg-57 mg/5 mL Oral Liq 50 mL [INYO] RXP12427 CDM 00143-9982-50 NDC facility both 50 ML 188.75 188.75 Gross Charge Type: Pharmacy amoxicillin-clavulanate 400 mg-57 mg/5 mL Oral Liq 50 mL [INYO] RXP12427 CDM 66685-1012-00 NDC facility both 50 ML 175.75 175.75 Gross Charge Type: Pharmacy lanolin Top Crm [INYO] RXP12428 CDM 44677-0102-02 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 7 APP lanolin Top Crm [INYO] RXP12428 CDM 92771-0590-07 NDC facility both 1 EA 100.8 100.8 Gross Charge Type: Pharmacy | NDC EA = 7 APP petrolatum Top 100% Oint [INYO] RXP12429 CDM 72140-0452-31 NDC facility both 1 EA 27.45 27.45 Gross Charge Type: Pharmacy | NDC EA = 50 APP argatroban 1 mg/mL [INYO] RXP12430 CDM J0883 HCPCS 00781-3314-95 NDC facility both 50 ML 1673.6 1673.6 Gross Charge Type: Pharmacy argatroban 1 mg/mL [INYO] RXP12430 CDM J0883 HCPCS 55150-0241-10 NDC facility both 50 ML 1755 1755 Gross Charge Type: Pharmacy argatroban 1 mg/mL [INYO] RXP12430 CDM J0883 HCPCS 42367-0203-84 NDC facility both 50 ML 1634.4 1634.4 Gross Charge Type: Pharmacy dabigatran 75 mg Cap [INYO] RXP12431 CDM 00597-0355-56 NDC facility both 1 EA 57.23 57.23 Gross Charge Type: Pharmacy | NDC EA = 1 CAP dabigatran 75 mg Cap [INYO] RXP12431 CDM 00597-0355-09 NDC facility both 1 EA 55.03 55.03 Gross Charge Type: Pharmacy | NDC EA = 1 CAP "ascorbic acid 25,000 mg/ 50 mL Sol [INYO]" RXP12432 CDM 67157-0101-50 NDC facility both 50 ML 1656 1656 Gross Charge Type: Pharmacy raltegravir 400 mg Tab [INYO] - ISENTRESS RXP12433 CDM 00006-0227-61 NDC facility both 1 EA 173.52 173.52 Gross Charge Type: Pharmacy | NDC EA = 1 TAB emtricitabine-tenofovir 200 mg-300 mg Tab [INYO] RXP12434 CDM 42385-0953-30 NDC facility both 1 EA 280.03 280.03 Gross Charge Type: Pharmacy emtricitabine-tenofovir 200 mg-300 mg Tab - TRUVADA RXP12434 CDM 61958-0701-01 NDC facility both 1 EA 294.77 294.77 Gross Charge Type: Pharmacy capsaicin topical 0.1% Cre [inyo] RXP12440 CDM 00536-1264-56 NDC facility both 1 EA 70.55 70.55 Gross Charge Type: Pharmacy | NDC EA = 42.5 APP capsaicin Top 0.1% Cream [INYO] RXP12440 CDM 41167-0751-42 NDC facility both 1 EA 52.2 52.2 Gross Charge Type: Pharmacy | NDC EA = 42.5 APP etonogestrel 68 mg Implant [INYO] RXP12441 CDM J7307 HCPCS 78206-0145-01 NDC facility both 1 EA 5243.9 5243.9 Gross Charge Type: Pharmacy etonogestrel 68 mg SC implant [INYO] RXP12441 CDM J7307 HCPCS 00052-4330-01 NDC facility both 1 EA 4487.12 4487.12 Gross Charge Type: Pharmacy "betamethasone Top dipropionate, augmented 0.05% Crm [INYO]" RXP12443 CDM 45802-0376-32 NDC facility both 1 EA 51.8 51.8 Gross Charge Type: Pharmacy | NDC EA = 50 APP "betamethasone topical dipropionate, augmented 0.05% Cre [inyo]" RXP12443 CDM 51672-1310-03 NDC facility both 1 EA 339.48 339.48 Gross Charge Type: Pharmacy | NDC EA = 50 APP ROPIVACAINE 0.2% 400 MG/200 ML [INYO] RXP12444 CDM J2795 HCPCS 25021-0671-87 NDC facility both 200 ML 556.2 556.2 Gross Charge Type: Pharmacy ROPIVACAINE 0.2% 400 MG/200 ML [INYO] RXP12444 CDM J2795 HCPCS 63323-0285-63 NDC facility both 200 ML 556.2 556.2 Gross Charge Type: Pharmacy panitumumab 20 mg/mL 5 mL Sol [INYO] RXP12445 CDM J9303 HCPCS 55513-0954-01 NDC facility both 5 ML 7697.95 7697.95 Gross Charge Type: Pharmacy panitumumab 20 mg/mL IV Sol [INYO] RXP12446 CDM J9303 HCPCS 55513-0956-01 NDC facility both 20 ML 15395.88 15395.88 Gross Charge Type: Pharmacy buprenorphine-naloxone 2 mg-0.5 mg sublingual Dis Tab [INYO] RXP12448 CDM J0572 HCPCS 00054-0188-13 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buprenorphine-naloxone 2 mg-0.5 mg sublingual Dis Tab [INYO] RXP12448 CDM J0572 HCPCS 60687-0626-65 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buprenorphine-naloxone 2 mg-0.5 mg sublingual Dis Tab [INYO] RXP12448 CDM J0572 HCPCS 00904-7009-06 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buprenorphine 2 mg sublingual Dis Tab [INYO] RXP12449 CDM J0571 HCPCS 60687-0481-21 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB buprenorphine 2 mg sublingual Dis Tab [INYO] RXP12449 CDM J0571 HCPCS 00054-0176-13 NDC facility both 1 EA 35 35 Gross Charge Type: Pharmacy | NDC EA = 1 TAB ePHEDrine 25 mg/5 mL-NS IV Sol [INYO] RXP12450 CDM 70092-1478-44 NDC facility both 5 ML 263.14 263.14 Gross Charge Type: Pharmacy ePHEDrine 25 mg/5 mL-NaCl 0.9% preservative-free Sol [inyo] RXP12450 CDM 71266-9027-01 NDC facility both 5 ML 348.56 348.56 Gross Charge Type: Pharmacy MIDAZOLAM 100MG/100ML-0.9%NACL [INYO] RXP12451 CDM J2250 HCPCS 44567-0611-10 NDC facility both 100 ML 287.9 287.9 Gross Charge Type: Pharmacy MIDAZOLAM 100MG/100ML-0.9%NACL [INYO] RXP12451 CDM J2250 HCPCS 70092-1030-36 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy MIDAZOLAM 100MG/100ML-0.9%NACL [INYO] RXP12451 CDM J2250 HCPCS 70092-1418-36 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy meropenem 500 mg IV Inj [INYO] RXP12453 CDM J2185 HCPCS 55150-0207-20 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy meropenem 500 mg Pow [INYO] RXP12453 CDM J2185 HCPCS 44567-0400-10 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy clonidine/epinephrine/ketorolac/ropivacaine 0.04 mg-0.25 mg-15 mg-123 mg/50 mL [INYO] RXP12454 CDM 70092-1433-50 NDC facility both 50 ML 330 330 Gross Charge Type: Pharmacy morphine 10 mg/0.5 mL ORAL Con [INYO] RXP12455 CDM 68094-0045-58 NDC facility both 1 ML 35 35 Gross Charge Type: Pharmacy mesna 100 mg/mL Inj Sol [INYO] RXP12456 CDM J9209 HCPCS 25021-0201-10 NDC facility both 10 ML 225 225 Gross Charge Type: Pharmacy etoposide 20 mg/mL IV Sol [INYO] RXP12457 CDM J9181 HCPCS 16729-0114-31 NDC facility both 5 ML 225 225 Gross Charge Type: Pharmacy ifosfamide 3 g IV Inj [INYO] RXP12458 CDM J9208 HCPCS 10019-0926-02 NDC facility both 1 EA 845 845 Gross Charge Type: Pharmacy filgrastim aafi 480 mcg/0.8 mL [INYO] RXP12460 CDM Q5110 HCPCS 00069-0292-10 NDC facility both 0.8 ML 2522.88 2522.88 Gross Charge Type: Pharmacy cemiplimab 350 mg/7 mL [INYO] RXP12462 CDM J9119 HCPCS 61755-0008-01 NDC facility both 7 ML 27300 27300 Gross Charge Type: Pharmacy Pediatric heparin flush 1 units/mL [INYO] RXP12464 CDM J1642 HCPCS 64253-0444-22 NDC facility both 2 ML 36 36 Gross Charge Type: Pharmacy OLANZapine 10 mg IM Inj [INYO] RXP12467 CDM S0166 HCPCS 00517-0955-01 NDC facility both 1 EA 361.76 361.76 Gross Charge Type: Pharmacy OLANZapine 10 mg IM Inj [INYO] RXP12467 CDM S0166 HCPCS 00781-3159-72 NDC facility both 1 EA 332 332 Gross Charge Type: Pharmacy OLANZapine 10 mg IM Inj [INYO] RXP12467 CDM S0166 HCPCS 55150-0308-01 NDC facility both 1 EA 340.24 340.24 Gross Charge Type: Pharmacy menthol-zinc oxide Top 0.44%-20.625% Oint [INYO] RXP12468 CDM 64980-0322-12 NDC facility both 1 EA 22.25 22.25 Gross Charge Type: Pharmacy | NDC EA = 113 APP esmolol 2500 mg/250mL Sol [INYO] RXP12469 CDM J1805 HCPCS 44567-0811-10 NDC facility both 250 ML 860.4 860.4 Gross Charge Type: Pharmacy methylene blue 5 mg/mL [INYO] RXP12470 CDM Q9968 HCPCS 00517-0374-05 NDC facility both 10 ML 1713.38 1713.38 Gross Charge Type: Pharmacy heparin 10000 units/mL Sol [inyo] RXP12471 CDM J1644 HCPCS 63323-0542-13 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy "heparin 10,000 units/mL Inj Sol [INYO]" RXP12471 CDM J1644 HCPCS 00641-0410-12 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy "heparin 10,000 units/mL Inj Sol [INYO]" RXP12471 CDM J1644 HCPCS 25021-0403-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy "heparin 10,000 units/mL Inj Sol [INYO]" RXP12471 CDM J1644 HCPCS 00409-2721-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy haloperidol 2 mg/mL Con 5 mL [INYO] RXP12472 CDM 00121-0581-05 NDC facility both 5 ML 25.14 25.14 Gross Charge Type: Pharmacy acetic acid Top 0.25% Sol 250 mL [INYO] RXP12474 CDM 00409-6143-22 NDC facility both 250 ML 31.5 31.5 Gross Charge Type: Pharmacy vancomycin 1 g/200 mL [INYO] RXP12475 CDM J3370 HCPCS 70594-0042-03 NDC facility both 200 ML 288 288 Gross Charge Type: Pharmacy vancomycin 125 mg Cap [INYO] RXP12476 CDM 23155-0858-78 NDC facility both 1 EA 156.53 156.53 Gross Charge Type: Pharmacy | NDC EA = 1 CAP vancomycin 125 mg Cap [INYO] RXP12476 CDM 00121-0867-20 NDC facility both 1 EA 156.53 156.53 Gross Charge Type: Pharmacy | NDC EA = 1 CAP vancomycin 125 mg Cap [INYO] RXP12476 CDM 68180-0166-13 NDC facility both 1 EA 156.53 156.53 Gross Charge Type: Pharmacy | NDC EA = 1 CAP cholecalciferol 2000 intl units Tab UD [INYO] RXP12477 CDM 50268-0865-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cholecalciferol 2000 intl units Tab UD [INYO] RXP12477 CDM 40985-0271-11 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "rabies immune globulin, human 300 intl units/mL [INYO]" RXP12478 CDM 13533-0318-01 NDC facility both 1 ML 4020 4020 Gross Charge Type: Pharmacy vancomycin 1.5 g/300 mL [INYO] RXP12479 CDM J3370 HCPCS 70594-0043-02 NDC facility both 300 ML 430 430 Gross Charge Type: Pharmacy prothrombin complex - Pow 500 units [INYO] RXP12482 CDM J7168 HCPCS 63833-0386-02 NDC facility both 1 EA 2865 2865 Gross Charge Type: Pharmacy | NDC EA = 1 VIALS vancomycin 2 g/400 mL [INYO] RXP12488 CDM J3370 HCPCS 70594-0044-02 NDC facility both 400 ML 432 432 Gross Charge Type: Pharmacy oseltamivir 30 mg Cap [INYO] RXP12489 CDM 68180-0675-11 NDC facility both 1 EA 70.9 70.9 Gross Charge Type: Pharmacy | NDC EA = 1 CAP oseltamivir 30 mg Cap [inyo] RXP12489 CDM 72205-0042-11 NDC facility both 1 EA 70.9 70.9 Gross Charge Type: Pharmacy | NDC EA = 1 CAP oseltamivir 30 mg Cap [INYO] RXP12489 CDM 00004-0802-85 NDC facility both 1 EA 83.61 83.61 Gross Charge Type: Pharmacy | NDC EA = 1 CAP heparin flush 10 units/mL [INYO] RXP1445 CDM J1642 HCPCS 64253-0222-35 NDC facility both 5 ML 36 36 Gross Charge Type: Pharmacy durvalumab 50 mg/mL 10 mL Sol [INYO] RXP1446 CDM J9173 HCPCS 00310-4611-50 NDC facility both 10 ML 18671.52 18671.52 Gross Charge Type: Pharmacy durvalumab 50 mg/mL [INYO] RXP1447 CDM J9173 HCPCS 00310-4500-12 NDC facility both 2.4 ML 5277.6 5277.6 Gross Charge Type: Pharmacy PANOPTIX IOL 19.5 TFNT0019.5 RXP15030 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 19.5 TFNT0019.5 RXP15030 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price Dextrose 5% with 0.45% NaCl and KCl 40 mEq/l IV Sol 1000 mL [INYO] RXP1559 CDM J3480 HCPCS 00409-7904-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl and KCl 40 mEq/l IV Sol 1000 mL [INYO] RXP1559 CDM J3480 HCPCS 00264-7638-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl and KCl 30 mEq/l IV Sol 1000 mL [INYO] RXP1560 CDM J3480 HCPCS 00409-7903-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy LVP solution with potassium Dextrose 5% with 0.45% NaCl and KCl 30 mEq/L Sol [INYO] RXP1560 CDM J3480 HCPCS 00990-7903-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl and KCl 30 mEq/l IV Sol 1000 mL [INYO] RXP1560 CDM J3480 HCPCS 00338-0673-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl and KCl 20 mEq/L Sol [INYO] RXP1561 CDM J3480 HCPCS 00990-7902-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl and KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP1561 CDM J3480 HCPCS 00264-7635-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.225% NaCl and KCl 20 mEq/L [INYO] RXP1562 CDM J3480 HCPCS 00409-7901-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% with KCl 40 mEq/l IV Sol 1000 mL [INYO] RXP1563 CDM J3480 HCPCS 00338-0695-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% with KCl 40 mEq/l IV Sol 1000 mL [INYO] RXP1563 CDM J3480 HCPCS 00409-7116-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Sodium Chloride 0.9% with KCl 40 mEq/l IV Sol 1000 mL [INYO] RXP1563 CDM J3480 HCPCS 00990-7116-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl and KCl 10 mEq/l IV Sol 1000 mL [INYO] RXP1564 CDM J3480 HCPCS 00409-7993-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy LVP solution with potassium Dextrose 5% with 0.45% NaCl and KCl 10 mEq/L Sol[inyo] RXP1564 CDM J3480 HCPCS 00338-0669-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with 0.45% NaCl and KCl 10 mEq/l IV Sol 1000 mL [INYO] RXP1564 CDM J3480 HCPCS 00264-7634-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Lactated Ringers with Potassium Chloride 20mEq/L [INYO] RXP1565 CDM J3480 HCPCS 00990-7111-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Lactated Ringers with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP1565 CDM J3480 HCPCS 00409-7111-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% in Lactated Ringers with KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP1565 CDM J3480 HCPCS 00338-0811-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with NS and KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP1566 CDM J3480 HCPCS 00990-7107-09 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy Dextrose 5% with NS and KCl 20 mEq/l IV Sol 1000 mL [INYO] RXP1566 CDM J3480 HCPCS 00264-7652-00 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy LVP solution with potassium Dextrose 5% with 0.9% NaCl and KCl 20 mEq/L Sol RXP1566 CDM J3480 HCPCS 00338-0803-04 NDC facility both 1000 ML 275 275 Gross Charge Type: Pharmacy DOBUTamine 250 mg/250 mL-D5W [INYO] RXP1567 CDM J1250 HCPCS 00409-2346-32 NDC facility both 250 ML 265 265 Gross Charge Type: Pharmacy DOBUTamine 250 mg/250 mL-D5W [INYO] RXP1567 CDM J1250 HCPCS 00338-1073-02 NDC facility both 250 ML 265 265 Gross Charge Type: Pharmacy measles/mumps/rubella virus vaccine SQ Inj [INYO] RXP1572 CDM 00006-4681-00 NDC facility both 1 ML 751.71 751.71 Gross Charge Type: Pharmacy idaruCIZUmab 2.5 g/50 mL [INYO] RXP1577 CDM C9399 HCPCS 00597-0197-05 NDC facility both 50 ML 12020.4 12020.4 Gross Charge Type: Pharmacy Dextrose 10% in Water IV Sol 250 mL [INYO] RXP1579 CDM 00338-0023-02 NDC facility both 250 ML 275 275 Gross Charge Type: Pharmacy permethrin Top 5% Crm [INYO] RXP1580 CDM 21922-0021-07 NDC facility both 1 EA 472 472 Gross Charge Type: Pharmacy | NDC EA = 60 APP permethrin Top 5% Crm [INYO] RXP1580 CDM 45802-0269-37 NDC facility both 1 EA 475.2 475.2 Gross Charge Type: Pharmacy | NDC EA = 60 APP valproic acid 250 mg/5 mL Oral Soln [INYO] RXP1581 CDM 00121-0675-85 NDC facility both 5 ML 6 6 Gross Charge Type: Pharmacy valproic acid 250 mg/5 mL Oral Syrup [INYO] RXP1581 CDM 00121-4675-05 NDC facility both 5 ML 6 6 Gross Charge Type: Pharmacy lanreotide 120 mg/0.5 mL SC Sol [INYO] RXP1582 CDM J1930 HCPCS 15054-1120-04 NDC facility both 0.5 ML 23901 23901 Gross Charge Type: Pharmacy atezolizumab 1200 mg/20 mL [INYO] RXP1583 CDM J9022 HCPCS 50242-0917-01 NDC facility both 20 ML 27041.25 27041.25 Gross Charge Type: Pharmacy olopatadine Ophth 0.2% Sol [INYO] RXP1584 CDM 60505-0586-04 NDC facility both 1 EA 717.6 717.6 Gross Charge Type: Pharmacy | NDC EA = 2.5 DROPS olopatadine Ophth 0.2% Sol [INYO] RXP1584 CDM 00536-1307-23 NDC facility both 1 EA 91.5 91.5 Gross Charge Type: Pharmacy | NDC EA = 2.5 DROPS olopatadine Ophth 0.2% Sol [INYO] RXP1584 CDM 00065-8150-01 NDC facility both 1 EA 100.02 100.02 Gross Charge Type: Pharmacy | NDC EA = 2.5 DROPS decitabine 50 mg (5 mg/mL) IV Inj [INYO] RXP1585 CDM J0894 HCPCS 25021-0231-20 NDC facility both 1 ML 7260 7260 Gross Charge Type: Pharmacy albumin human 25% IV Sol 100 mL [INYO] RXP1586 CDM P9047 HCPCS 00944-0493-02 NDC facility both 100 ML 1520 1520 Gross Charge Type: Pharmacy albumin human 25% IV Sol 100 mL [INYO] RXP1586 CDM P9047 HCPCS 44206-0251-10 NDC facility both 100 ML 1560 1560 Gross Charge Type: Pharmacy albumin human 25% IV Sol [inyo] RXP1586 CDM P9047 HCPCS 76125-0792-10 NDC facility both 100 ML 1520 1520 Gross Charge Type: Pharmacy albumin human 25% IV Sol 100 mL [INYO] RXP1586 CDM P9047 HCPCS 68982-0643-02 NDC facility both 100 ML 918 918 Gross Charge Type: Pharmacy albumin human 25% IV Sol 100 mL [INYO] RXP1586 CDM P9047 HCPCS 68516-5216-02 NDC facility both 100 ML 1520 1520 Gross Charge Type: Pharmacy lactobacillus acidophilus/casei/rhamnosus - Cap [INYO] RXP1587 CDM 26608-0001-50 NDC facility both 1 EA 11.23 11.23 Gross Charge Type: Pharmacy | NDC EA = 1 CAP sodium zirconium cyclosilicate 5 g Pow [INYO] RXP1588 CDM 00310-1105-30 NDC facility both 1 EA 134.93 134.93 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS sodium zirconium cyclosilicate 5 g Pow [INYO] RXP1588 CDM 00310-1105-39 NDC facility both 1 EA 141.67 141.67 Gross Charge Type: Pharmacy | NDC EA = 1 PACKETS propylthiouracil 50 mg Tab [INYO] RXP1589 CDM 00228-2348-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB perflutren (protein-type A microspheres) Sus [INYO] RXP1590 CDM Q9957 HCPCS 00407-2707-03 NDC facility both 3 ML 1520 1520 Gross Charge Type: Pharmacy sodium bicarbonate 4.2% IV Sol 5 mL [INYO] RXP1591 CDM 00409-5555-02 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy sodium bicarbonate 4.2% IV Sol 5 mL [INYO] RXP1591 CDM 63323-0083-05 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy ibuprofen 100 mg/5 mL Sus UD [INYO] RXP1593 CDM 68094-0494-62 NDC facility both 5 ML 6 6 Gross Charge Type: Pharmacy ibuprofen 100 mg/5 mL Sus UD [INYO] RXP1593 CDM 00121-0914-00 NDC facility both 5 ML 6 6 Gross Charge Type: Pharmacy leuprolide 7.5 mg/month Kit [INYO] RXP1594 CDM J9217 HCPCS 00074-3642-03 NDC facility both 1 EA 12264.6 12264.6 Gross Charge Type: Pharmacy leuprolide 30 mg/4 months Kit [INYO] RXP1596 CDM J9217 HCPCS 00074-3683-03 NDC facility both 1 EA 19971.18 19971.18 Gross Charge Type: Pharmacy "fluorouracil 1,000 mg/20 mL Sol [INYO]" RXP1599 CDM J9190 HCPCS 63323-0117-20 NDC facility both 20 ML 504 504 Gross Charge Type: Pharmacy "fluorouracil 1,000 mg/20 mL Sol [INYO]" RXP1599 CDM J9190 HCPCS 70700-0187-23 NDC facility both 20 ML 225 225 Gross Charge Type: Pharmacy fluorouracil 2500 mg/50 mL Sol [INYO] RXP1600 CDM J9190 HCPCS 70700-0188-22 NDC facility both 50 ML 240.66 240.66 Gross Charge Type: Pharmacy fluorouracil 2500 mg/50 mL IV Sol [INYO] RXP1600 CDM J9190 HCPCS 16729-0276-11 NDC facility both 50 ML 240.66 240.66 Gross Charge Type: Pharmacy pramipexole 0.25 mg Tab [INYO] RXP1601 CDM 00904-6704-61 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB pramipexole 0.25 mg Tab [inyo] RXP1601 CDM 60687-0570-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB EUCERIN CREME [INYO] RXP1604 CDM 72140-0038-68 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 57 APP Epinephrine 100 mcg/10 mL [INYO] RXP1606 CDM 70092-1617-46 NDC facility both 10 ML 1520 1520 Gross Charge Type: Pharmacy acetaminophen 160 mg/5 mL Sus [INYO] RXP1607 CDM 00904-7278-70 NDC facility both 5 ML 6 6 Gross Charge Type: Pharmacy acetaminophen 160 mg/5 mL Sus [INYO] RXP1607 CDM 68094-0231-61 NDC facility both 5 ML 6 6 Gross Charge Type: Pharmacy Acetaminophen 160mg/ 5 mL Cup [INYO] RXP1607 CDM 68094-0231-62 NDC facility both 5 ML 6.06 6.06 Gross Charge Type: Pharmacy acetaminophen 160 mg/5 mL Sus RXP1607 CDM 00121-0966-00 NDC facility both 5 ML 8.52 8.52 Gross Charge Type: Pharmacy Acetaminophen 160mg/ 5 mL Cup [INYO] RXP1607 CDM 00121-1781-05 NDC facility both 5 ML 8.34 8.34 Gross Charge Type: Pharmacy hyoscyamine 0.125 mg Dis Tab [INYO] RXP1610 CDM 42192-0338-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hyoscyamine 0.125 mg Dis Tab [INYO] RXP1610 CDM 43199-0012-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB benralizumab 30 mg/mL [INYO] RXP1611 CDM J0517 HCPCS 00310-1730-30 NDC facility both 1 EA 15200 15200 Gross Charge Type: Pharmacy diphenhydrAMINE-zinc acetate Top 2%-0.1% Crm [INYO] RXP1612 CDM 00904-5354-31 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 28 APP leucovorin 350 mg Pow [INYO] RXP1613 CDM J0640 HCPCS 25021-0816-30 NDC facility both 1 EA 672 672 Gross Charge Type: Pharmacy leucovorin 350 mg Pow [INYO] RXP1613 CDM J0640 HCPCS 67457-0530-35 NDC facility both 1 EA 249.6 249.6 Gross Charge Type: Pharmacy leucovorin 350 mg IV Inj [INYO] RXP1613 CDM J0640 HCPCS 00143-9552-01 NDC facility both 1 EA 249.6 249.6 Gross Charge Type: Pharmacy chlorthalidone 25 mg Tab [INYO] RXP1614 CDM 00904-6900-61 NDC facility both 1 EA 15.72 15.72 Gross Charge Type: Pharmacy | NDC EA = 1 TAB chlorthalidone 25 mg Tab [INYO] RXP1614 CDM 60687-0317-25 NDC facility both 1 EA 13.79 13.79 Gross Charge Type: Pharmacy | NDC EA = 1 TAB chlorthalidone 25 mg Tab [INYO] RXP1614 CDM 00904-6900-04 NDC facility both 1 EA 14.25 14.25 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cefTAZidime 2 g Inj [INYO] RXP1616 CDM J0713 HCPCS 25021-0128-50 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy cefTAZidime 2 g Inj [INYO] RXP1616 CDM J0713 HCPCS 00409-5084-11 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy elosulfase alfa 1 mg/mL [INYO] RXP1617 CDM J1322 HCPCS 68135-0100-01 NDC facility both 5 ML 6408 6408 Gross Charge Type: Pharmacy degarelix 80 mg Pow [INYO] RXP1619 CDM J9155 HCPCS 55566-8303-01 NDC facility both 1 EA 2930.7 2930.7 Gross Charge Type: Pharmacy degarelix 120 mg Pow [INYO] RXP1620 CDM J9155 HCPCS 55566-8403-01 NDC facility both 1 EA 4572.55 4572.55 Gross Charge Type: Pharmacy prednisoLONE 15 mg Tab ODT [INYO] RXP1621 CDM J7510 HCPCS 66993-0845-35 NDC facility both 1 EA 115.08 115.08 Gross Charge Type: Pharmacy | NDC EA = 1 TAB remdesivir 100 mg Pow [INYO] RXP1622 CDM J0248 HCPCS 61958-2901-02 NDC facility both 1 ML 4020 4020 Gross Charge Type: Pharmacy tranexamic acid 1000 mg/100mL-NaCl 0.7% Sol [INYO] RXP1623 CDM 51754-0108-03 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy lidocaine topical 2% 100 mL Sol [INYO] RXP1624 CDM 50383-0775-04 NDC facility both 100 ML 68.75 68.75 Gross Charge Type: Pharmacy lidocaine topical 2% 100 mL Sol [INYO] RXP1624 CDM 60432-0464-00 NDC facility both 100 ML 66 66 Gross Charge Type: Pharmacy eculizumab 10 mg/mL Sol [INYO] RXP1626 CDM J1300 HCPCS 25682-0001-01 NDC facility both 30 ML 17076 17076 Gross Charge Type: Pharmacy SUBLOCADE 100 mg/0.5 mL ERS [INYO] RXP1628 CDM Q9991 HCPCS 12496-0100-01 NDC facility both 0.5 ML 12099.12 12099.12 Gross Charge Type: Pharmacy SUBLOCADE 300 mg/1.5 mL ERS [INYO] RXP1629 CDM Q9992 HCPCS 12496-0300-01 NDC facility both 1.5 ML 12099.12 12099.12 Gross Charge Type: Pharmacy cefTRIAXone 500 mg Pow [INYO] RXP1630 CDM J0696 HCPCS 60505-6152-01 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy albuterol 90 mcg/inh Aer 8.5 g [INYO] RXP1633 CDM 68180-0963-01 NDC facility both 1 EA 260 260 Gross Charge Type: Pharmacy | NDC EA = 8.5 INH albuterol 90 mcg/inh Aer 8.5 g [INYO] RXP1633 CDM 00093-3174-31 NDC facility both 1 EA 260 260 Gross Charge Type: Pharmacy | NDC EA = 8.5 INH hepatitis B adult vaccine 20 mcg/mL Sus [INYO] RXP1634 CDM 58160-0821-52 NDC facility both 1 ML 593.86 593.86 Gross Charge Type: Pharmacy hepatitis B adult vaccine 20 mcg/mL Sus [INYO] RXP1634 CDM 58160-0821-11 NDC facility both 1 ML 593.86 593.86 Gross Charge Type: Pharmacy BIOTENE DRY MOUTH SPRAY [INYO] RXP1637 CDM A9155 HCPCS 48582-0001-55 NDC facility both 1 EA 26.35 26.35 Gross Charge Type: Pharmacy | NDC EA = 44.3 SPRAYS leuprolide 45 mg/6 months ER Pow [INYO] RXP1639 CDM J9217 HCPCS 62935-0453-45 NDC facility both 1 EA 13008.64 13008.64 Gross Charge Type: Pharmacy vancomycin 1.25 g/250 mL Sol [INYO] RXP1641 CDM J3370 HCPCS 70594-0057-02 NDC facility both 250 ML 360 360 Gross Charge Type: Pharmacy vancomycin 1.75 g/350 mL Sol [INYO] RXP1642 CDM J3370 HCPCS 70594-0058-02 NDC facility both 350 ML 504 504 Gross Charge Type: Pharmacy "daratumumab-hyaluronidase FIHJ 1800 mg-30,000 units/15 mL Sol [INYO]" RXP1643 CDM J9144 HCPCS 57894-0503-01 NDC facility both 15 ML 29079.2 29079.2 Gross Charge Type: Pharmacy fluticasone furoate 100 mcg Pow [INYO] RXP1644 CDM 00173-0874-14 NDC facility both 1 EA 36.82 36.82 Gross Charge Type: Pharmacy | NDC EA = 1 INH dexmedetomidine 80 mcg 20 mL [INYO] RXP1647 CDM 00409-1660-20 NDC facility both 20 ML 1890 1890 Gross Charge Type: Pharmacy dexmedetomidine 80 mcg 20mL [INYO] RXP1647 CDM 63323-0671-20 NDC facility both 20 ML 249.6 249.6 Gross Charge Type: Pharmacy dexmedetomidine 80 mcg 20 mL [INYO] RXP1647 CDM 00781-3493-95 NDC facility both 20 ML 260 260 Gross Charge Type: Pharmacy antivenin (black widow spider) 6000 units Pow [INYO] RXP1648 CDM 00006-5424-02 NDC facility both 1 EA 266.02 266.02 Gross Charge Type: Pharmacy | NDC EA = 1 VIALS vancomycin 750 mg/150 mL Sol [INYO] RXP1649 CDM J3370 HCPCS 70594-0056-03 NDC facility both 150 ML 235 235 Gross Charge Type: Pharmacy LORazepam 60 mg/30 mL Con [INYO] RXP1651 CDM 00054-3532-44 NDC facility both 30 ML 240.15 240.15 Gross Charge Type: Pharmacy Diclofenac Sodium 1% topical gel [INYO] RXP1654 CDM 70000-0555-02 NDC facility both 1 EA 82.45 82.45 Gross Charge Type: Pharmacy | NDC EA = 100 APP tocilizumab 400 mg/20mL [INYO] RXP1658 CDM J3262 HCPCS 50242-0137-01 NDC facility both 20 ML 12645 12645 Gross Charge Type: Pharmacy midazolam 50 mg/10 mL Sol [INYO] RXP1660 CDM J2250 HCPCS 00641-6060-01 NDC facility both 10 ML 440 440 Gross Charge Type: Pharmacy KANJINTI 420 mg Pow [INYO] RXP1661 CDM Q5117 HCPCS 55513-0132-01 NDC facility both 1 EA 17746.84 17746.84 Gross Charge Type: Pharmacy Kanjinti - trastuzumab anns 420 mg Pow [INYO] RXP1661 CDM Q5117 HCPCS 55513-0164-01 NDC facility both 1 EA 18279.28 18279.28 Gross Charge Type: Pharmacy dexmedetomidine 400MCG/100ML PB [INYO] RXP1662 CDM 00338-9557-12 NDC facility both 100 ML 576 576 Gross Charge Type: Pharmacy fentaNYL 50 mcg/mL 1 mL Sol [INYO] RXP1663 CDM J3010 HCPCS 63323-0806-01 NDC facility both 1 ML 170 170 Gross Charge Type: Pharmacy "fentaNYL 2,500 mcg/50 mL Sol [INYO]" RXP1664 CDM J3010 HCPCS 00641-6030-01 NDC facility both 50 ML 256.48 256.48 Gross Charge Type: Pharmacy leuprolide 22.5 mg/3 months Pow [INYO] RXP1665 CDM J9217 HCPCS 62935-0227-10 NDC facility both 1 EA 8130.4 8130.4 Gross Charge Type: Pharmacy | NDC EA = 1 KITS leuprolide 22.5 mg/3 months Pow [INYO] RXP1665 CDM J9217 HCPCS 62935-0223-05 NDC facility both 1 EA 8130.4 8130.4 Gross Charge Type: Pharmacy | NDC EA = 1 KITS mepolizumab 100 mg/mL Sol [INYO] RXP1667 CDM J2182 HCPCS 00173-0892-01 NDC facility both 1 ML 14976.91 14976.91 Gross Charge Type: Pharmacy cyclophosphamide 1 g Pow RXP1668 CDM J9070 HCPCS 70121-1239-01 NDC facility both 1 EA 3955.5 3955.5 Gross Charge Type: Pharmacy cyclophosphamide 1 g Pow RXP1668 CDM J9070 HCPCS 00781-3244-94 NDC facility both 1 EA 4120.3 4120.3 Gross Charge Type: Pharmacy cyclophosphamide 1 g IV Inj [INYO] RXP1668 CDM J9070 HCPCS 10019-0956-01 NDC facility both 1 EA 4395 4395 Gross Charge Type: Pharmacy chloroprocaine 2% PF Inj Sol 20 mL [INYO] RXP1669 CDM J2400 HCPCS 63323-0477-27 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy chloroprocaine 2% PF Inj Sol 20 mL [INYO] RXP1669 CDM J2400 HCPCS 00143-9209-10 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy dacarbazine 200 mg Inj [INYO] RXP1671 CDM J9130 HCPCS 00703-5075-01 NDC facility both 1 EA 225 225 Gross Charge Type: Pharmacy dexamethasone/neomycin/polymyxin B Ophth Oint [INYO] RXP1672 CDM 00574-4160-35 NDC facility both 1 EA 90.9 90.9 Gross Charge Type: Pharmacy | NDC EA = 3.5 APP dexamethasone/neomycin/polymyxin B Ophth Oint [INYO] RXP1672 CDM 00065-0631-36 NDC facility both 1 EA 935.48 935.48 Gross Charge Type: Pharmacy | NDC EA = 3.5 APP MULTIHANCE 529 mg/mL Sol 10 mL [INYO] RXP1674 CDM A9577 HCPCS 00270-5164-13 NDC facility both 10 ML 558.37 558.37 Gross Charge Type: Pharmacy MULTIHANCE 529 mg/mL Sol 5 mL [INYO] RXP1675 CDM A9577 HCPCS 00270-5164-12 NDC facility both 5 ML 284.61 284.61 Gross Charge Type: Pharmacy MULTIHANCE 529 mg/mL Sol 15 mL [INYO] RXP1676 CDM A9577 HCPCS 00270-5164-14 NDC facility both 15 ML 817.09 817.09 Gross Charge Type: Pharmacy naltrexone 50 mg Tab UD [INYO] RXP1678 CDM 00904-7036-04 NDC facility both 1 EA 12.85 12.85 Gross Charge Type: Pharmacy | NDC EA = 1 TAB hydrocortisone/neomycin/polymyxin B Otic Susp [INYO] RXP1681 CDM 24208-0635-62 NDC facility both 1 EA 402.72 402.72 Gross Charge Type: Pharmacy | NDC EA = 10 DROPS lanreotide 60 mg/0.2 mL SC Sol [INYO] RXP1684 CDM J1930 HCPCS 15054-1060-04 NDC facility both 0.2 ML 15216 15216 Gross Charge Type: Pharmacy onabotulinumtoxinA 50 units Pow [INYO] RXP1686 CDM J0585 HCPCS 00023-3919-50 NDC facility both 1 EA 2383.2 2383.2 Gross Charge Type: Pharmacy sildenafil 50 mg Tab [INYO] RXP1687 CDM 00069-4210-30 NDC facility both 1 EA 356.08 356.08 Gross Charge Type: Pharmacy | NDC EA = 1 TAB sterile water 1000 mL Inj Sol [INYO] RXP1688 CDM A4217 HCPCS 00264-7850-00 NDC facility both 1000 ML 235 235 Gross Charge Type: Pharmacy omega-3 polyunsaturated fatty acids ethyl esters 1000 mg Cap [INYO] RXP1690 CDM 60505-3170-07 NDC facility both 1 EA 12.41 12.41 Gross Charge Type: Pharmacy | NDC EA = 1 CAP omega-3 polyunsaturated fatty acids ethyl esters 1000 mg Cap [INYO] RXP1690 CDM 31722-0936-12 NDC facility both 1 EA 16.15 16.15 Gross Charge Type: Pharmacy | NDC EA = 1 CAP ivermectin 3 mg Tab UD [INYO] RXP1691 CDM 42799-0806-01 NDC facility both 1 EA 29.81 29.81 Gross Charge Type: Pharmacy | NDC EA = 1 TAB divalproex sodium 250 mg ER Tab [INYO] RXP1692 CDM 65862-0594-01 NDC facility both 1 EA 14.73 14.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB divalproex sodium 250 mg Tab [INYO] RXP1692 CDM 50268-0259-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB divalproex sodium 250 mg ER Tab [INYO] RXP1692 CDM 00904-6363-61 NDC facility both 1 EA 9.31 9.31 Gross Charge Type: Pharmacy | NDC EA = 1 TAB divalproex sodium 250 mg ER Tab [INYO] RXP1692 CDM 65162-0755-10 NDC facility both 1 EA 14.73 14.73 Gross Charge Type: Pharmacy | NDC EA = 1 TAB doxycycline hyclate 100 mg Tab UD [INYO] RXP1693 CDM 00904-0430-04 NDC facility both 1 EA 27.28 27.28 Gross Charge Type: Pharmacy | NDC EA = 1 TAB doxycycline hyclate 100 mg Tab UD [INYO] RXP1693 CDM 00143-2112-50 NDC facility both 1 EA 33.19 33.19 Gross Charge Type: Pharmacy | NDC EA = 1 TAB DOPamine 40 mg/mL Sol [INYO] RXP1694 CDM J1265 HCPCS 00143-9252-25 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy "calcium gluconate 1,000mg/50mL-NaCl 0.67% Sol [INYO]" RXP1696 CDM J0613 HCPCS 44567-0620-24 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy loxapine 50 mg Cap [INYO] RXP1697 CDM 00591-0372-01 NDC facility both 1 EA 15.43 15.43 Gross Charge Type: Pharmacy | NDC EA = 1 CAP YERVOY 200 mg/40mL Sol [INYO] RXP1698 CDM J9228 HCPCS 00003-2328-22 NDC facility both 40 ML 91366.92 91366.92 Gross Charge Type: Pharmacy sodium bicarbonate 8.4% IV Sol 50 mL vial [INYO] RXP1699 CDM 51754-5001-04 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy sodium bicarbonate 8.4% IV Sol 50 mL vial [INYO] RXP1699 CDM 76329-3352-01 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy sodium bicarbonate 8.4% IV Sol 50 mL vial [INYO] RXP1699 CDM 00409-6625-02 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy sodium bicarbonate 8.4% IV Sol 50mL vial [INYO] RXP1699 CDM 63323-0089-50 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy sodium bicarbonate 8.4% IV Sol 50 mL vial [INYO] RXP1699 CDM 51754-5001-05 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy sodium bicarbonate 8.4% IV Sol 50 mL vial [INYO] RXP1699 CDM 51754-5001-01 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy sodium bicarbonate 8.4% IV Sol 50 mL vial [INYO] RXP1699 CDM 00409-6637-34 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy etomidate 2 mg/mL Sol [inyo] RXP1700 CDM 65219-0447-20 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy etomidate 40 mg/ 20 mL Sol [INYO] RXP1700 CDM 00143-9507-10 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy etomidate 40 mg/ 20 mL Sol [INYO] RXP1700 CDM 72266-0147-10 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy Amino Acids 5% with 20% Dextrose and Electrolytes (Clinimix E Sulfite-Free) intravenous solution Amino Acids 5% with 20% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol [INYO] RXP1701 CDM 00338-1125-04 NDC facility both 2000 ML 330 330 Gross Charge Type: Pharmacy Meningococcal B Vaccine [INYO] RXP1702 CDM 58160-0976-06 NDC facility both 0.5 ML 1520 1520 Gross Charge Type: Pharmacy Meningococcal B Vaccine [INYO] RXP1702 CDM 58160-0976-20 NDC facility both 0.5 ML 1520 1520 Gross Charge Type: Pharmacy vitamin A and D topical 42.5g [INYO] RXP1704 CDM 65197-0400-10 NDC facility both 1 EA 17 17 Gross Charge Type: Pharmacy | NDC EA = 42.5 APP vitamin A & D topical 42.5 g [INYO] RXP1704 CDM 11523-7204-01 NDC facility both 1 EA 17 17 Gross Charge Type: Pharmacy | NDC EA = 42.5 APP miconazole topical 2% Cre 45 g [INYO] RXP1707 CDM 51672-0203-56 NDC facility both 1 EA 57.25 57.25 Gross Charge Type: Pharmacy | NDC EA = 45 APP miconazole topical 2% Cre 45 g [INYO] RXP1707 CDM 51672-2035-06 NDC facility both 1 EA 57.25 57.25 Gross Charge Type: Pharmacy | NDC EA = 45 APP clindamycin 600 mg- D5%/50 mL Sol [INYO] RXP1708 CDM J0736 HCPCS 00781-3289-09 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy clindamycin 600 mg- D5%/50 mL Sol [INYO] RXP1708 CDM J0736 HCPCS 00338-3612-24 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy potassium acetate 100 mEq/50mL Sol [INYO] RXP1713 CDM 00409-3294-51 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy potassium acetate 40 mEq/ 20mL IV Sol [INYO] RXP1714 CDM 00409-8183-01 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy "immune globulin 10% 10,000mg/100mL IV [INYO]" RXP1715 CDM J1599 HCPCS 61953-0005-02 NDC facility both 100 ML 4020 4020 Gross Charge Type: Pharmacy immune globulin 10% 20G/200mL IV Sol [INYO] RXP1716 CDM J1599 HCPCS 61953-0005-03 NDC facility both 200 ML 10252.08 10252.08 Gross Charge Type: Pharmacy tocilizumab 200 mg/10mL Sol [INYO] RXP1723 CDM J3262 HCPCS 50242-0136-01 NDC facility both 10 ML 6419.88 6419.88 Gross Charge Type: Pharmacy bacitracin topical zinc 500 units/g Oin [INYO] RXP1724 CDM 14428-0008-88 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 14 APP bacitracin topical zinc 500 units/g Oin [inyo] RXP1724 CDM 51672-2075-01 NDC facility both 1 EA 22.87 22.87 Gross Charge Type: Pharmacy | NDC EA = 14 APP "fat emulsion, intravenous with fish, medium chain, olive, and soy oil 20% [INYO]" RXP1726 CDM 63323-0820-74 NDC facility both 250 ML 265 265 Gross Charge Type: Pharmacy cholecalciferol 400 intl units Tab [INYO] RXP1727 CDM 50268-0863-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB cholecalciferol 400 intl units Tab [INYO] RXP1727 CDM 77333-0948-10 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "diphtheria/pertussis,acel/tetanus/polio [INYO]" RXP1729 CDM 58160-0812-52 NDC facility both 0.5 ML 529.34 529.34 Gross Charge Type: Pharmacy proparacaine Ophth 0.5% Sol [INYO] RXP1730 CDM 61314-0016-01 NDC facility both 1 EA 263.28 263.28 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS proparacaine ophthalmic 0.5% Sol RXP1730 CDM 24208-0730-06 NDC facility both 1 EA 252.66 252.66 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS inFLIXimab dyyb 100 mg Pow [INYO] RXP1731 CDM Q5103 HCPCS 00069-0809-01 NDC facility both 1 ML 5677.7 5677.7 Gross Charge Type: Pharmacy ZARXIO 480 MCG/0.8 ML SYRINGE [INYO] RXP1734 CDM Q5101 HCPCS 61314-0326-01 NDC facility both 0.8 ML 4020 4020 Gross Charge Type: Pharmacy ZARXIO 480 MCG/0.8 ML SYRINGE [INYO] RXP1734 CDM Q5101 HCPCS 61314-0326-10 NDC facility both 0.8 ML 4020 4020 Gross Charge Type: Pharmacy cephalexin 250 mg Cap UD [INYO] RXP1735 CDM 50268-0151-15 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 CAP digoxin immune FAB 40 mg Pow [INYO] RXP1737 CDM J1162 HCPCS 50633-0120-11 NDC facility both 1 EA 11922 11922 Gross Charge Type: Pharmacy gemcitabine 2g/52.6mL [INYO] RXP1738 CDM J9201 HCPCS 67457-0618-10 NDC facility both 52.6 ML 673.96 673.96 Gross Charge Type: Pharmacy hydrocortisone-pramoxine 1%-1% Crm w/Appl RECTAL [INYO] RXP1739 CDM 45802-0144-64 NDC facility both 1 EA 582.32 582.32 Gross Charge Type: Pharmacy | NDC EA = 30 APP capecitabine 500 mg Tab [INYO] RXP1741 CDM J8521 HCPCS 00004-1101-50 NDC facility both 1 EA 260 260 Gross Charge Type: Pharmacy | NDC EA = 1 TAB "epoetin alfa 20,000 units/mL Inj Sol [INYO]" RXP1742 CDM J0885 HCPCS 59676-0320-04 NDC facility both 1 ML 4020 4020 Gross Charge Type: Pharmacy Dextrose 5% with 0.2% NaCl and KCl 20 mEq/L IV SOL 1000mL [INYO] RXP1743 CDM J3480 HCPCS 00264-7645-00 NDC facility both 1000 ML 235 235 Gross Charge Type: Pharmacy leuprolide 7.5 mg/month ER POW[INYO] RXP1744 CDM J9217 HCPCS 62935-0753-75 NDC facility both 1 EA 2710.15 2710.15 Gross Charge Type: Pharmacy multihance Sol 20 mL [INYO] RXP1745 CDM A9577 HCPCS 00270-5164-15 NDC facility both 20 ML 1009.02 1009.02 Gross Charge Type: Pharmacy gadoxetate 181.43 mg/mL Sol [INYO] RXP1746 CDM A9581 HCPCS 50419-0320-05 NDC facility both 10 ML 1520 1520 Gross Charge Type: Pharmacy VISINE EYE MULTI SYMPTOM 15ML [INYO] RXP1747 CDM 12547-0493-86 NDC facility both 1 EA 37.8 37.8 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS Zirabev 100mg/4mL [INYO] RXP1749 CDM Q5118 HCPCS 00069-0315-01 NDC facility both 4 ML 3680.4 3680.4 Gross Charge Type: Pharmacy Zirabev 400mg/16ml[INYO] RXP1750 CDM Q5118 HCPCS 00069-0342-01 NDC facility both 16 ML 12645 12645 Gross Charge Type: Pharmacy MONUROL 3 g Pow [INYO] RXP1751 CDM 00456-4300-01 NDC facility both 1 EA 438.08 438.08 Gross Charge Type: Pharmacy DOCEtaxel 160 mg/ 8 mL Sol [INYO] RXP1755 CDM J9171 HCPCS 16729-0267-65 NDC facility both 1 ML 2190.9 2190.9 Gross Charge Type: Pharmacy ILUMYA 100 mg/mL Sol [INYO] RXP1758 CDM J3245 HCPCS 47335-0177-95 NDC facility both 1 ML 39768 39768 Gross Charge Type: Pharmacy bumetanide 2.5 mg/10 mL Sol [INYO] RXP1759 CDM J3490 HCPCS 00641-6007-10 NDC facility both 10 ML 235 235 Gross Charge Type: Pharmacy KADCYLA ado-trastuzumab emtansine 100 mg Pow [INYO] RXP1760 CDM J9354 HCPCS 50242-0088-01 NDC facility both 1 EA 14700.52 14700.52 Gross Charge Type: Pharmacy KADCYLA ado-trastuzumab emtansine 160 mg Pow [INYO] RXP1761 CDM J9354 HCPCS 50242-0087-01 NDC facility both 1 EA 15200 15200 Gross Charge Type: Pharmacy acetaminophen-hydrocodone 325 mg-7.5 mg/15 mL ORAL Sol [INYO] RXP1762 CDM 60687-0417-71 NDC facility both 15 ML 35 35 Gross Charge Type: Pharmacy acetaminophen-hydrocodone 325 mg-7.5 mg/15 mL ORAL Sol [INYO] RXP1762 CDM 66689-0023-50 NDC facility both 15 ML 35 35 Gross Charge Type: Pharmacy ketamine 50mg/5mL PFS [INYO] RXP1763 CDM 70092-9119-44 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy PACLitaxel 100 mg/16.7 mL Sol [INYO] RXP1764 CDM J9267 HCPCS 61703-0342-22 NDC facility both 16.7 ML 225 225 Gross Charge Type: Pharmacy magnesium sulfate 4 g/100 mL-sterile water Sol [INYO] RXP1765 CDM J3475 HCPCS 47335-0992-02 NDC facility both 100 ML 1520 1520 Gross Charge Type: Pharmacy magnesium sulfate 4 g/100 mL-sterile water Sol [INYO] RXP1765 CDM J3475 HCPCS 00409-6729-23 NDC facility both 100 ML 235 235 Gross Charge Type: Pharmacy magnesium sulfate 4 g/100 mL-sterile water Sol [INYO] RXP1765 CDM J3475 HCPCS 00264-4206-54 NDC facility both 100 ML 235 235 Gross Charge Type: Pharmacy Tepezza 500 mg Pow [INYO] RXP1768 CDM J3241 HCPCS 75987-0130-15 NDC facility both 1 EA 44700 44700 Gross Charge Type: Pharmacy | NDC EA = 1 VIALS obinutuzumab 1000 mg/40mL Sol [INYO] RXP1773 CDM J9301 HCPCS 50242-0070-01 NDC facility both 40 ML 19653 19653 Gross Charge Type: Pharmacy irinotecan liposomal 43 mg/10 mL [INYO] RXP1774 CDM J9205 HCPCS 69171-0398-01 NDC facility both 10 ML 9720 9720 Gross Charge Type: Pharmacy irinotecan liposomal 43 mg/10 mL [INYO] RXP1774 CDM J9205 HCPCS 15054-0043-01 NDC facility both 10 ML 12645 12645 Gross Charge Type: Pharmacy golimumab 50 mg/4 mL Sol [INYO] RXP1777 CDM J1602 HCPCS 57894-0350-01 NDC facility both 4 ML 11995.15 11995.15 Gross Charge Type: Pharmacy OLANZapine 5 mg Dis Tab [INYO] RXP1778 CDM 55111-0262-81 NDC facility both 1 EA 12.45 12.45 Gross Charge Type: Pharmacy | NDC EA = 1 TAB midazolam 5 mg/5 mL preservative-free Sol [INYO] RXP1781 CDM J2250 HCPCS 00409-2305-05 NDC facility both 5 ML 170 170 Gross Charge Type: Pharmacy baricitinib 2 mg Tab [INYO] RXP1783 CDM 00002-4182-30 NDC facility both 1 EA 380.54 380.54 Gross Charge Type: Pharmacy | NDC EA = 1 - norepinephrine 4 mg/250 mL-D5% Sol[INYO] RXP1785 CDM 00338-0112-20 NDC facility both 250 ML 240 240 Gross Charge Type: Pharmacy norepinephrine 4 mg/250 mL-D5% Sol [INYO] RXP1785 CDM 70092-1034-17 NDC facility both 250 ML 235 235 Gross Charge Type: Pharmacy acetaminophen/butalbital/caffeine 300 mg-50 mg-40 mg Cap [INYO] RXP1786 CDM 70010-0044-01 NDC facility both 1 EA 28.88 28.88 Gross Charge Type: Pharmacy | NDC EA = 1 TAB immune globulin Gammagard 10% 20G/ 200mL [INYO] RXP1787 CDM J1561 HCPCS 00944-2700-06 NDC facility both 200 ML 10171.2 10171.2 Gross Charge Type: Pharmacy immune globulin intravenous and subcutaneous 10% Sol RXP1788 CDM J1561 HCPCS 13533-0800-71 NDC facility both 100 ML 4639.68 4639.68 Gross Charge Type: Pharmacy "immune globulin GAMUNEX-C 10% 5,000mg/ 50mL [INYO]" RXP1789 CDM J1561 HCPCS 13533-0800-20 NDC facility both 50 ML 4020 4020 Gross Charge Type: Pharmacy avibactam-ceftazidime 0.5 g-2 g Pow [INYO] RXP1791 CDM J0714 HCPCS 00456-2700-10 NDC facility both 1 EA 2583.43 2583.43 Gross Charge Type: Pharmacy "hyaluronidase/pertuzumab/trastuzumab 20,000 units-600 mg-600 mg/10 mL Sol [INYO]" RXP1793 CDM J9316 HCPCS 50242-0260-01 NDC facility both 10 ML 25413 25413 Gross Charge Type: Pharmacy amiodarone 360 mg/200 mL-D5% Sol [INYO] RXP1794 CDM J0282 HCPCS 43066-0360-20 NDC facility both 200 ML 430 430 Gross Charge Type: Pharmacy amiodarone 150 mg/100 mL-D5% Sol [INYO] RXP1795 CDM J0282 HCPCS 43066-0150-10 NDC facility both 100 ML 333.02 333.02 Gross Charge Type: Pharmacy "immune globulin GAMUNEX-C 10% 20,000MG/ 200mL [INYO]" RXP1797 CDM J1561 HCPCS 13533-0800-24 NDC facility both 200 ML 10020 10020 Gross Charge Type: Pharmacy riTUXimab arrx 500 mg/50 mL Sol [INYO] RXP1799 CDM Q5123 HCPCS 55513-0326-01 NDC facility both 50 ML 17203.2 17203.2 Gross Charge Type: Pharmacy dalbavancin 500 mg Pow [INYO] RXP1800 CDM J0875 HCPCS 57970-0100-01 NDC facility both 1 EA 7815.16 7815.16 Gross Charge Type: Pharmacy riTUXimab abbs 500 mg/50 mL Sol [INYO] RXP1801 CDM Q5115 HCPCS 63459-0104-50 NDC facility both 50 ML 15200 15200 Gross Charge Type: Pharmacy riTUXimab abbs 100 mg/10mL [INYO] RXP1802 CDM Q5115 HCPCS 63459-0103-10 NDC facility both 10 ML 5073.3 5073.3 Gross Charge Type: Pharmacy immune globulin GAMMAGARD 10% 10G/100mL vial [INYO] RXP1803 CDM J1569 HCPCS 00944-2700-05 NDC facility both 100 ML 10020 10020 Gross Charge Type: Pharmacy immune globulin GAMMAGARD 10% 5G /50mL Sol [INYO] RXP1804 CDM J1569 HCPCS 00944-2700-04 NDC facility both 50 ML 4020 4020 Gross Charge Type: Pharmacy avelumab 200 mg/10mL Sol [INYO] RXP1805 CDM J9023 HCPCS 44087-3535-01 NDC facility both 10 ML 7884.15 7884.15 Gross Charge Type: Pharmacy Dextrose 5% with 0.9% NS 500 mL [INYO] RXP1806 CDM J7042 HCPCS 63323-0870-10 NDC facility both 500 ML 235 235 Gross Charge Type: Pharmacy menthol-methyl salicylate topical 1%-15% Cream [INYO] RXP1807 CDM 00536-1101-45 NDC facility both 85 EA 38 38 Gross Charge Type: Pharmacy morphine 100 mg/100mL-NaCl 0.9% preservative-free [INYO] RXP1810 CDM J2274 HCPCS 70092-1380-36 NDC facility both 100 ML 265 265 Gross Charge Type: Pharmacy luspatercept- aamt 75 mg Pow [INYO] RXP1812 CDM J0896 HCPCS 59572-0775-01 NDC facility both 1 EA 34883 34883 Gross Charge Type: Pharmacy eptinezumab 100 mg/mL Sol [INYO] RXP1817 CDM J3032 HCPCS 67386-0130-51 NDC facility both 1 ML 7176 7176 Gross Charge Type: Pharmacy Clinimix E Sulfite-Free Amino Acids 5% with 20% Dextrose and Electrolytes 1000mL [INYO] RXP1818 CDM 250 HCPCS 00338-1148-03 NDC facility both 1000 ML 430 430 Gross Charge Type: Pharmacy triamcinolone topical 0.1% Paste 5G [INYO] RXP1819 CDM 51672-1267-05 NDC facility both 1 EA 80.59 80.59 Gross Charge Type: Pharmacy POLYVINYL ocular lubricant preserved Sol 15mL [INYO] RXP1826 CDM 00536-1325-94 NDC facility both 1 EA 31.4 31.4 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS propranolol 60 mg ER Cap [INYO] RXP1830 CDM 60687-0215-01 NDC facility both 1 EA 13.09 13.09 Gross Charge Type: Pharmacy | NDC EA = 1 - lithium 450 mg Tab UD [INYO] RXP1831 CDM 51079-0142-20 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 - lithium 450 mg Tab [inyo] RXP1831 CDM 68084-0655-01 NDC facility both 1 EA 6 6 Gross Charge Type: Pharmacy | NDC EA = 1 - glycopyrrolate 0.2 mg/mL Sol [inyo] RXP1835 CDM 71288-0414-03 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy glycopyrrolate 0.2 mg/mL Sol [INYO] RXP1835 CDM 43547-0543-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy glycopyrrolate 0.2 mg/mL Sol [inyo] RXP1835 CDM 71839-0123-25 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy glycopyrrolate 0.2 mg/mL Sol [INYO] RXP1835 CDM 16729-0471-08 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy DESITIN DIAPER RASH MAX STRENGTH PASTE 1 OZ [INYO] RXP1839 CDM 69968-0006-11 NDC facility both 1 EA 36 36 Gross Charge Type: Pharmacy | NDC EA = 28 APP "fluorouracil 5,000 mg/100 mL Sol [INYO]" RXP1840 CDM J9190 HCPCS 16729-0276-38 NDC facility both 100 ML 481.25 481.25 Gross Charge Type: Pharmacy "fluorouracil 5,000 mg/100 mL Sol [INYO]" RXP1840 CDM J9190 HCPCS 63323-0117-61 NDC facility both 100 ML 225 225 Gross Charge Type: Pharmacy "fluorouracil 5,000 mg/ 100 mL Sol [INYO]" RXP1840 CDM J9190 HCPCS 70700-0189-22 NDC facility both 100 ML 481.25 481.25 Gross Charge Type: Pharmacy "fluorouracil 5,000 mg/100 mL Sol [INYO}" RXP1840 CDM J9190 HCPCS 25021-0215-99 NDC facility both 100 ML 462 462 Gross Charge Type: Pharmacy nivolumab-relatlimab rmbw 240 mg-80 mg/20 mL Sol [INYO] RXP1841 CDM J9298 HCPCS 00003-7125-11 NDC facility both 20 ML 34235.68 34235.68 Gross Charge Type: Pharmacy bevacizumab awwb 400 mg/16 mL Sol [INYO] RXP1842 CDM Q5107 HCPCS 55513-0207-01 NDC facility both 16 ML 13006.08 13006.08 Gross Charge Type: Pharmacy immune globulin GAMMAGARD 10% 30G/300mL IV Sol [INYO] RXP1843 CDM J1569 HCPCS 00944-2700-07 NDC facility both 300 ML 13971.6 13971.6 Gross Charge Type: Pharmacy immune globulin GAMMAGARD 10% 30G/300mL IV Sol [INYO] RXP1843 CDM J1569 HCPCS 00944-2700-13 NDC facility both 300 ML 13971.6 13971.6 Gross Charge Type: Pharmacy leucovorin 500 mg Pow [INYO] RXP1844 CDM J0640 HCPCS 63323-0711-00 NDC facility both 1 EA 755.6 755.6 Gross Charge Type: Pharmacy bevacizumab awwb 100 mg/4 mL Sol [INYO] RXP1845 CDM Q5107 HCPCS 55513-0206-01 NDC facility both 4 ML 4186.4 4186.4 Gross Charge Type: Pharmacy oxaliplatin 50 mg/10 mL Sol [INYO] RXP1846 CDM J9263 HCPCS 16729-0332-03 NDC facility both 10 ML 1273.14 1273.14 Gross Charge Type: Pharmacy clindamycin 900 mg-5%/50 mL Sol [INYO] RXP1847 CDM J0736 HCPCS 00781-3290-09 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy clindamycin 900 mg-5%/50 mL Sol [INYO] RXP1847 CDM J0736 HCPCS 00338-3814-24 NDC facility both 50 ML 235 235 Gross Charge Type: Pharmacy "epoetin alfa 10,000 units/mL preservative-free Sol [INYO]" RXP1848 CDM Q4081 HCPCS 59676-0310-01 NDC facility both 1 ML 1924.2 1924.2 Gross Charge Type: Pharmacy amoxicillin 200 mg/5 mL Pow 100mL [INYO] RXP1849 CDM 00143-9886-01 NDC facility both 100 ML 54.84 54.84 Gross Charge Type: Pharmacy amoxicillin 125 mg/5 mL Pow 100mL [INYO] RXP1850 CDM 00143-9888-01 NDC facility both 100 ML 21.36 21.36 Gross Charge Type: Pharmacy Biotene Dry Mouth saliva substitutes - Gel 42G[INYO] RXP1851 CDM 48582-0512-01 NDC facility both 1 EA 28.25 28.25 Gross Charge Type: Pharmacy | NDC EA = 42 APP CHLOROPROCAINE 3% PF 20ML [INYO] RXP1853 CDM J2401 HCPCS 63323-0478-27 NDC facility both 20 ML 235 235 Gross Charge Type: Pharmacy amoxicillin 400 mg/5 mL Pow 75mL [INYO] RXP1854 CDM 00093-4161-78 NDC facility both 75 ML 48.98 48.98 Gross Charge Type: Pharmacy ParaGard COPPER IUD 68.7mg [INYO] RXP1856 CDM J7300 HCPCS 59365-5128-01 NDC facility both 1 EA 2891 2891 Gross Charge Type: Pharmacy | NDC EA = 1 - valproic acid 250 mg Cap [inyo] RXP1857 CDM 69452-0150-20 NDC facility both 1 EA 10.04 10.04 Gross Charge Type: Pharmacy | NDC EA = 1 - valproic acid 250 mg Cap [INYO] RXP1857 CDM 71930-0057-12 NDC facility both 1 EA 7.52 7.52 Gross Charge Type: Pharmacy | NDC EA = 1 - morphine 10 mg/0.5 mL SOLUTION [INYO] RXP1858 CDM 68094-0056-58 NDC facility both 1 ML 35 35 Gross Charge Type: Pharmacy pegfilgrastim kit 6 mg/0.6 mL Sol [INYO] RXP1859 CDM J2506 HCPCS 55513-0192-01 NDC facility both 0.6 ML 19253.97 19253.97 Gross Charge Type: Pharmacy Fentanyl - Ropivacaine- 200 mcg/100 mL[INYO] RXP1860 CDM J7999 HCPCS 70092-1108-36 NDC facility both 100 ML 235.28 235.28 Gross Charge Type: Pharmacy droperidol 5 mg/ 2 mL [INYO] RXP1861 CDM J1790 HCPCS 00517-9702-25 NDC facility both 2 ML 235 235 Gross Charge Type: Pharmacy "immune globulin 10% PRIVIGEN 10,000mg/100mL [INYO]" RXP1863 CDM J1459 HCPCS 44206-0437-10 NDC facility both 100 ML 10020 10020 Gross Charge Type: Pharmacy "immune globulin 10% PRIVIGEN 20,000mg/200mL [INYO]" RXP1864 CDM J1459 HCPCS 44206-0438-20 NDC facility both 200 ML 10048.2 10048.2 Gross Charge Type: Pharmacy Amino Acids 4.25% with 5% Dextrose and Electrolytes (Clinimix E Sulfite-Free) intravenous solution Amino Acids 4.25% with 5% Dextrose and Electrolytes (Clinimix E Sulfite-Free) Sol RXP1865 CDM 00338-1113-04 NDC facility both 2000 ML 716.96 716.96 Gross Charge Type: Pharmacy filgrastim 480 mcg/0.8 mL Sol [INYO] RXP1866 CDM J1442 HCPCS 55513-0209-10 NDC facility both 0.8 ML 4020 4020 Gross Charge Type: Pharmacy levETIRAcetam 1000 mg/100 mL-NaCl 0.75% [INYO] RXP1867 CDM J1953 HCPCS 67457-0265-10 NDC facility both 1000 ML 1548 1548 Gross Charge Type: Pharmacy levETIRAcetam 1000 mg/100 mL-NaCl 0.75% [INYO] RXP1867 CDM J1953 HCPCS 55150-0247-47 NDC facility both 1000 ML 4020 4020 Gross Charge Type: Pharmacy pegfilgrastim jmdb 6 mg/0.6 mL Sol [INYO] RXP1869 CDM Q5108 HCPCS 67457-0833-06 NDC facility both 0.6 ML 12525 12525 Gross Charge Type: Pharmacy darbepoetin alfa 200 mcg/0.4 mL Inj Sol [INYO] RXP1870 CDM J0881 HCPCS 55513-0028-01 NDC facility both 0.4 ML 7430.4 7430.4 Gross Charge Type: Pharmacy PACLitaxel 150mg/25mL [INYO] RXP1871 CDM J9267 HCPCS 00703-3217-01 NDC facility both 25 ML 554.4 554.4 Gross Charge Type: Pharmacy EPINEPHrine 10 mg/10mL Sol [INYO] rxp1872 CDM J0171 HCPCS 54288-0120-01 NDC facility both 10 ML 784.8 784.8 Gross Charge Type: Pharmacy levOCARNitine 1000 mg/5mL Sol [INYO] RXP1873 CDM J1955 HCPCS 54482-0147-01 NDC facility both 5 ML 353.01 353.01 Gross Charge Type: Pharmacy ARANESP 500 mcg/mL Sol [INYO] RXP1874 CDM J0881 HCPCS 55513-0032-01 NDC facility both 1 ML 18576 18576 Gross Charge Type: Pharmacy ravulizumab 1100 mg/11mL Sol [INYO] RXP1875 CDM J1303 HCPCS 25682-0028-01 NDC facility both 11 ML 70444 70444 Gross Charge Type: Pharmacy ravulizumab 300 mg/3mL Sol [INYO] RXP1876 CDM J1303 HCPCS 25682-0025-01 NDC facility both 3 ML 19212 19212 Gross Charge Type: Pharmacy RHo (D) immune globulin Rhophylac 1500 intl units/2 mL Sol [INYO] RXP1877 CDM J2791 HCPCS 44206-0300-01 NDC facility both 2 ML 1520 1520 Gross Charge Type: Pharmacy ARIPiprazole 300 mg Pow syringe [INYO] RXP1878 CDM J0401 HCPCS 59148-0045-80 NDC facility both 1 EA 10020 10020 Gross Charge Type: Pharmacy cabotegravir 600 mg/3 mL Sus [INYO] RXP1879 CDM J0739 HCPCS 49702-0264-23 NDC facility both 3 ML 11266.5 11266.5 Gross Charge Type: Pharmacy dilTIAZem 125 mg/25mL Sol [INYO] RXP1880 CDM 00641-6015-10 NDC facility both 125 ML 436.8 436.8 Gross Charge Type: Pharmacy risankizumab rzaa 600 mg/10 mL Sol [INYO] RXP1883 CDM J2327 HCPCS 00074-5015-01 NDC facility both 10 ML 27409.2 27409.2 Gross Charge Type: Pharmacy acetic acid topical 0.25% Sol 500mL [INYO] RXP1884 CDM 00264-2304-10 NDC facility both 500 ML 49.83 49.83 Gross Charge Type: Pharmacy mineral oil 100% Oral Liq 10 mL [INYO] RXP1885 CDM 63323-0254-10 NDC facility both 10 ML 83.52 83.52 Gross Charge Type: Pharmacy "influenza virus vaccine, inactivated preservative-free quadrivalent Sus" RXP1888 CDM 58160-0909-52 NDC facility both 0.5 ML 235 235 Gross Charge Type: Pharmacy riTUXimab arrx 100 mg/10 mL Sol [INYO] RXP1892 CDM Q5123 HCPCS 55513-0224-01 NDC facility both 10 ML 4300.8 4300.8 Gross Charge Type: Pharmacy riTUXimab pvvr 500 mg/50mL Sol [INYO] RXP1893 CDM Q5119 HCPCS 00069-0249-01 NDC facility both 50 ML 17203.2 17203.2 Gross Charge Type: Pharmacy riTUXimab pvvr 100 mg/10mL Sol [INYO] RXP1894 CDM Q5119 HCPCS 00069-0238-01 NDC facility both 10 ML 4300.8 4300.8 Gross Charge Type: Pharmacy romosozumab 105 mg/1.17 mL Sol [INYO] RXP1895 CDM J3111 HCPCS 55513-0998-02 NDC facility both 1.17 ML 6008.98 6008.98 Gross Charge Type: Pharmacy romosozumab 105 mg/1.17 mL Sol [INYO] RXP1895 CDM J3111 HCPCS 55513-0880-02 NDC facility both 1.17 ML 5564.26 5564.26 Gross Charge Type: Pharmacy deferoxamine 500 mg Pow [INYO] RXP1899 CDM J0895 HCPCS 60505-6236-06 NDC facility both 1 EA 235 235 Gross Charge Type: Pharmacy vinCRIStine 1 mg/mL Sol [INYO] RXP1900 CDM J9370 HCPCS 61703-0309-06 NDC facility both 1 ML 225 225 Gross Charge Type: Pharmacy esmolol 2500 mg/250 mL NaCl Sol [INYO] RXP1901 CDM J1805 HCPCS 67457-0657-25 NDC facility both 250 ML 3027.23 3027.23 Gross Charge Type: Pharmacy insulin isophane Humulin N (NPH) 10mL [INYO] RXP1901 CDM J1815 HCPCS 00002-8315-01 NDC facility both 10 ML 1520 1520 Gross Charge Type: Pharmacy tenecteplase 50 mg Pow Kit [INYO] RXP1902 CDM J3101 HCPCS 50242-0120-47 NDC facility both 1 EA 22798.83 22798.83 Gross Charge Type: Pharmacy dexamethasone ORAL VIAL 10 mg/ 1 mL PF [INYO] RXP1903 CDM J8540 HCPCS 63323-0506-01 NDC facility both 1 ML 45.07 45.07 Gross Charge Type: Pharmacy Dexamethasone ORAL vial 10 mg/ 1 mL PF [INYO] RXP1903 CDM J8540 HCPCS 55150-0304-25 NDC facility both 1 ML 31.68 31.68 Gross Charge Type: Pharmacy dexamethasone ORAL VIAL 10 mg/ 1 mL PF [INYO] RXP1903 CDM J8540 HCPCS 70069-0021-25 NDC facility both 1 ML 37.73 37.73 Gross Charge Type: Pharmacy cloZAPine 100 mg Tab [INYO] RXP1909 CDM 65862-0846-05 NDC facility both 1 EA 24.74 24.74 Gross Charge Type: Pharmacy | NDC EA = 1 TAB lidocaine-prilocaine topical 2.5%-2.5% Cre [INYO] RXP1911 CDM 00168-0357-55 NDC facility both 1 EA 15 15 Gross Charge Type: Pharmacy | NDC EA = 1 BOTTLES Clear Eyes Natural Tears Drops [INYO] RXP1912 CDM 78112-0736-45 NDC facility both 1 EA 353.85 353.85 Gross Charge Type: Pharmacy | NDC EA = 15 DROPS brimonidine-timolol ophthalmic 0.2%-0.5% Sol [INYO] RXP1914 CDM 82182-0455-05 NDC facility both 1 EA 886.52 886.52 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS tinidazole 500 mg Tab [INYO] RXP1915 CDM 42799-0208-01 NDC facility both 1 EA 55.75 55.75 Gross Charge Type: Pharmacy | NDC EA = 1 - cefadroxil 500 mg Cap [INYO] RXP1916 CDM 16714-0388-02 NDC facility both 1 EA 21.6 21.6 Gross Charge Type: Pharmacy | NDC EA = 1 - ZARXIO 300 mcg/0.5 mL Sol [INYO] RXP1917 CDM Q5101 HCPCS 61314-0318-01 NDC facility both 1 ML 4020 4020 Gross Charge Type: Pharmacy risperiDONE 4 mg ODT Tab [INYO] RXP1918 CDM 59746-0050-22 NDC facility both 1 EA 75.79 75.79 Gross Charge Type: Pharmacy | NDC EA = 1 TAB Mag- Al Plus Simethicone 200 mg-200 mg-20 mg/5 mL 30mL Sus UD [INYO] RXP1919 CDM 00121-1761-30 NDC facility both 30 ML 22.76 22.76 Gross Charge Type: Pharmacy nystatin 100000 units/mL Sus RXP1920 CDM 00904-7276-92 NDC facility both 5 ML 7.34 7.34 Gross Charge Type: Pharmacy brimonidine ophthalmic 0.2% Sol 5mL [INYO] RXP1921 CDM 61314-0143-05 NDC facility both 1 EA 72 72 Gross Charge Type: Pharmacy | NDC EA = 5 DROPS insulin regular human recombinant 100 units/mL Sol 10mL [INYO] RXP1922 CDM J1817 HCPCS 00002-8215-01 NDC facility both 10 ML 428.26 428.26 Gross Charge Type: Pharmacy belimumab 200 mg/mL Sol [INYO] RXP1924 CDM J0490 HCPCS 49401-0088-35 NDC facility both 1 ML 7263.75 7263.75 Gross Charge Type: Pharmacy tezepelumab ekko 210 mg/1.91 mL Sol [INYO] RXP1925 CDM J2356 HCPCS 55513-0112-01 NDC facility both 1.91 ML 19390.66 19390.66 Gross Charge Type: Pharmacy ketamine 50MG/5ML Sol [INYO] RXP1926 CDM 71266-9080-02 NDC facility both 5 ML 235 235 Gross Charge Type: Pharmacy phenylephrine 100 mcg/mL Sol RXP1927 CDM J2371 HCPCS 71266-9010-01 NDC facility both 1 ML 235 235 Gross Charge Type: Pharmacy epinephrine/lidocaine/tetracaine topical 0.18%-4%-0.5% Gel RXP1928 CDM 71266-6290-01 NDC facility both 3 ML 80 80 Gross Charge Type: Pharmacy ferumoxytol 510 mg/17 mL Sol [INYO] RXP1929 CDM Q0138 HCPCS 00781-3154-01 NDC facility both 17 ML 4345.68 4345.68 Gross Charge Type: Pharmacy ferumoxytol 510 mg/17 mL Sol [INYO] RXP1929 CDM Q0138 HCPCS 59338-0775-01 NDC facility both 17 ML 5562.48 5562.48 Gross Charge Type: Pharmacy Releuko filgrastim ayow 480 mcg/0.8 mL Sol [INYO] RXP1930 CDM Q5125 HCPCS 70121-1570-01 NDC facility both 0.8 ML 1520 1520 Gross Charge Type: Pharmacy brentuximab vedotin 50 mg Pow [INYO] RXP1931 CDM J9042 HCPCS 51144-0050-01 NDC facility both 1 EA 35226 35226 Gross Charge Type: Pharmacy PANOPTIX IOL 20.0 TFNT3020.0 RXP70101 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price PANOPTIX IOL 20.0 TFNT3020.0 RXP70101 CDM 276 RC facility both 995 995 Gross Charge Type: NIHD_Hosp_Profee_Price DAPTOmycin 500 mg IV Inj [INYO] RXPJ0878 CDM J0878 HCPCS 71288-0016-15 NDC facility both 1 EA 330 330 Gross Charge Type: Pharmacy DAPTOmycin 500 mg IV Inj [INYO] RXPJ0878 CDM J0878 HCPCS 67457-0813-50 NDC facility both 1 EA 558 558 Gross Charge Type: Pharmacy DAPTOmycin 500 mg IV Inj [INYO] RXPJ0878 CDM J0878 HCPCS 00703-0125-01 NDC facility both 1 EA 378 378 Gross Charge Type: Pharmacy DAPTOmycin 500 mg IV Inj [INYO] RXPJ0878 CDM J0878 HCPCS 25021-0174-15 NDC facility both 1 EA 1602 1602 Gross Charge Type: Pharmacy DAPTOmycin 500 mg IV Inj [INYO] RXPJ0878 CDM J0878 HCPCS 71288-0018-10 NDC facility both 1 EA 360 360 Gross Charge Type: Pharmacy DAPTOmycin 500 mg IV Inj [INYO] RXPJ0878 CDM J0878 HCPCS 67919-0011-01 NDC facility both 1 EA 1603.77 1603.77 Gross Charge Type: Pharmacy immune globulin 5% IV Sol 200 mL [INYO] RXPJ1572 CDM J1599 HCPCS 61953-0004-04 NDC facility both 200 ML 4020 4020 Gross Charge Type: Pharmacy "S0020 Injection, bupivicaine hydrochloride, 30 ml" S0020 CDM 636 RC J0665 HCPCS facility both 43 43 Gross Charge Type: NIHD_RHC_Price "S0020 Injection, bupivicaine hydrochloride, 30 ml" S0020 CDM 636 RC J0665 HCPCS facility both 43 43 Gross Charge Type: NIHD_Clinic_Price S4993 Apri S4993 CDM 636 RC S4993 HCPCS facility both 21 21 Gross Charge Type: NIHD_RHC_Price S4993 Apri S4993 CDM 636 RC S4993 HCPCS facility both 21 21 Gross Charge Type: NIHD_Clinic_Price S4993 AVIANE S49931 CDM 636 RC S4993 HCPCS facility both 38 38 Gross Charge Type: NIHD_RHC_Price S4993 AVIANE S49931 CDM 636 RC S4993 HCPCS facility both 40 40 Gross Charge Type: NIHD_Clinic_Price S4993 CRYSELLE S49932 CDM 636 RC S4993 HCPCS facility both 211 211 Gross Charge Type: NIHD_RHC_Price S4993 CRYSELLE S49932 CDM 636 RC S4993 HCPCS facility both 211 211 Gross Charge Type: NIHD_Clinic_Price S4993 ELLA S49933 CDM 636 RC S4993 HCPCS facility both 35 35 Gross Charge Type: NIHD_RHC_Price S4993 ELLA S49933 CDM 636 RC S4993 HCPCS facility both 35 35 Gross Charge Type: NIHD_Clinic_Price S4993 PLAN B S49934 CDM 636 RC S4993 HCPCS facility both 47 47 Gross Charge Type: NIHD_RHC_Price S4993 PLAN B S49934 CDM 636 RC S4993 HCPCS facility both 47 47 Gross Charge Type: NIHD_Clinic_Price S4993 NORLYDA S49935 CDM 636 RC S4993 HCPCS facility both 324 324 Gross Charge Type: NIHD_RHC_Price S4993 NORLYDA S49935 CDM 636 RC S4993 HCPCS facility both 324 324 Gross Charge Type: NIHD_Clinic_Price S4993 YAZ (DROSPIRENONE/ETHINYL ESTRADIOL) S49937 CDM 636 RC S4993 HCPCS facility both 78 78 Gross Charge Type: NIHD_RHC_Price S4993 YAZ (DROSPIRENONE/ETHINYL ESTRADIOL) S49937 CDM 636 RC S4993 HCPCS facility both 78 78 Gross Charge Type: NIHD_Clinic_Price "S5199 Personal care item, nos, each" S5199 CDM 521 RC S5199 HCPCS facility both 26 26 Gross Charge Type: NIHD_RHC_Price "S5199 Personal care item, nos, each" S5199 CDM 521 RC S5199 HCPCS facility both 26 26 Gross Charge Type: NIHD_Clinic_Price "S9445 Patient education, not otherwise classified, non-physician provider, individual, per session" S9445 CDM 521 RC S9445 HCPCS facility both 16 16 Gross Charge Type: NIHD_RHC_Price "S9445 Patient education, not otherwise classified, non-physician provider, individual, per session" S9445 CDM 521 RC S9445 HCPCS facility both 16 16 Gross Charge Type: NIHD_Clinic_Price "S9446 Patient education, not otherwise classified, non-physician provider, group, per session" S9446 CDM 521 RC S9446 HCPCS facility both 8 8 Gross Charge Type: NIHD_RHC_Price "S9446 Patient education, not otherwise classified, non-physician provider, group, per session" S9446 CDM 521 RC S9446 HCPCS facility both 8 8 Gross Charge Type: NIHD_Clinic_Price LANGUAGE EVAL INYO PROFEE SPX4300 CDM 982 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price LANGUAGE EVAL INYO PROFEE SPX4300 CDM 982 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price SPEECH EVAL INYO PROFEE SPX4301 CDM 982 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price SPEECH EVAL INYO PROFEE SPX4301 CDM 982 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price SPEECH LANG TREATMENT PER HOUR INYO PROFEE SPX4303 CDM 982 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price SPEECH LANG TREATMENT PER HOUR INYO PROFEE SPX4303 CDM 982 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price SPEECH LANG TREATMENT PER 30 MIN INYO PROFEE SPX4304 CDM 982 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price SPEECH LANG TREATMENT PER 30 MIN INYO PROFEE SPX4304 CDM 982 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price SGD PER VISIT INYO PROFEE SPX4310 CDM 982 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price SGD PER VISIT INYO PROFEE SPX4310 CDM 982 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price Removal Foreign Body Eye SUR01004 CDM 360 RC facility both 5665 5665 Gross Charge Type: NIHD_Hosp_Profee_Price Removal Foreign Body Eye SUR01004 CDM 360 RC facility both 5665 5665 Gross Charge Type: NIHD_Hosp_Profee_Price Viscocanalostomy SUR01013 CDM 360 RC facility both 12968 12968 Gross Charge Type: NIHD_Hosp_Profee_Price Viscocanalostomy SUR01013 CDM 360 RC facility both 12968 12968 Gross Charge Type: NIHD_Hosp_Profee_Price Revision Cataract SUR01016 CDM 360 RC facility both 9680 9680 Gross Charge Type: NIHD_Hosp_Profee_Price Revision Cataract SUR01016 CDM 360 RC facility both 9680 9680 Gross Charge Type: NIHD_Hosp_Profee_Price Ablation Tissue Prostate SUR03018 CDM 360 RC facility both 15289 15289 Gross Charge Type: NIHD_Hosp_Profee_Price Ablation Tissue Prostate SUR03018 CDM 360 RC facility both 15289 15289 Gross Charge Type: NIHD_Hosp_Profee_Price Colonoscopy Endoscopic Ultrasound SUR03030 CDM 360 RC facility both 3169 3169 Gross Charge Type: NIHD_Hosp_Profee_Price Colonoscopy Endoscopic Ultrasound SUR03030 CDM 360 RC facility both 3169 3169 Gross Charge Type: NIHD_Hosp_Profee_Price Examination Under Anesthesia Rectum SUR03032 CDM 360 RC facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price Examination Under Anesthesia Rectum SUR03032 CDM 360 RC facility both 2495 2495 Gross Charge Type: NIHD_Hosp_Profee_Price GENERAL ANESTHESIA ADD 15 MINS SUR04011 CDM 370 RC facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price GENERAL ANESTHESIA ADD 15 MINS SUR04011 CDM 370 RC facility both 589 589 Gross Charge Type: NIHD_Hosp_Profee_Price "T1015 Clinic visit/encounter, all-inclusive" T1015 CDM 521 RC T1015 HCPCS facility both 216 216 Gross Charge Type: NIHD_RHC_Price DRESSING 4X4 KERRALITE COOL HYDROGEL 5EA/BX WCS10020 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price DRESSING 4X4 KERRALITE COOL HYDROGEL 5EA/BX WCS10020 CDM 272 RC facility both 19 19 Gross Charge Type: NIHD_Hosp_Profee_Price X3908 TREATMENT 30 MIN CHARGE X39082 CDM 420 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price X3908 TREATMENT 30 MIN CHARGE X39082 CDM 420 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price X3910 TREATMENT ADD 15 MINUTES CHARGE X39102 CDM 420 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price X3910 TREATMENT ADD 15 MINUTES CHARGE X39102 CDM 420 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price X3920 INITIAL ASSESSMENT W/ REPORT 30' X39201 CDM 424 RC facility both 382 382 Gross Charge Type: NIHD_Hosp_Profee_Price X3920 INITIAL ASSESSMENT W/ REPORT 30' X39201 CDM 424 RC facility both 382 382 Gross Charge Type: NIHD_Hosp_Profee_Price X3922 INITIAL ASSESSMENT W/ REPORT ADDT'L 15' X39221 CDM 424 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price X3922 INITIAL ASSESSMENT W/ REPORT ADDT'L 15' X39221 CDM 424 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price X4100 EVAL INITIAL 30 MINUTES CHARGE X4100 CDM 430 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price X4100 EVAL INITIAL 30 MINUTES CHARGE X4100 CDM 430 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price X4100 EVAL INITIAL 30 MINUTES CHARGE X41001 CDM 430 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price X4100 EVAL INITIAL 30 MINUTES CHARGE X41001 CDM 430 RC facility both 375 375 Gross Charge Type: NIHD_Hosp_Profee_Price X4102 EVAL ADDITIONAL 15 MINUTES CHARGE X4102 CDM 430 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price X4102 EVAL ADDITIONAL 15 MINUTES CHARGE X4102 CDM 430 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price X4102 EVAL ADDITIONAL 15 MINUTES CHARGE X41021 CDM 430 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price X4102 EVAL ADDITIONAL 15 MINUTES CHARGE X41021 CDM 430 RC facility both 188 188 Gross Charge Type: NIHD_Hosp_Profee_Price X4110 TREATMENT INITIAL 30 MINUTES CHARGE X4110 CDM 430 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price X4110 TREATMENT INITIAL 30 MINUTES CHARGE X4110 CDM 430 RC facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price X4110 TREATMENT INITIAL 30 MINUTES CHARGE X41101 CDM facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price X4110 TREATMENT INITIAL 30 MINUTES CHARGE X41101 CDM facility both 227 227 Gross Charge Type: NIHD_Hosp_Profee_Price X4112 TREATMENT ADDITIONAL 15 MINUTES CHARGE X4112 CDM 430 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price X4112 TREATMENT ADDITIONAL 15 MINUTES CHARGE X4112 CDM 430 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price X4112 TREATMENT ADDITIONAL 15 MINUTES CHARGE X41121 CDM 430 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price X4112 TREATMENT ADDITIONAL 15 MINUTES CHARGE X41121 CDM 430 RC facility both 114 114 Gross Charge Type: NIHD_Hosp_Profee_Price X4300 LANGUAGE EVAL CHARGE X4300 CDM 440 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price X4300 LANGUAGE EVAL CHARGE X4300 CDM 440 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price X4301 SPEECH EVAL CHARGE X4301 CDM 440 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price X4301 SPEECH EVAL CHARGE X4301 CDM 440 RC facility both 563 563 Gross Charge Type: NIHD_Hosp_Profee_Price X4303 SPEECH LANG TREATMENT PER HOUR CHARGE X4303 CDM 440 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price X4303 SPEECH LANG TREATMENT PER HOUR CHARGE X4303 CDM 440 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price X4304 SPEECH LANG TREATMENT PER 30 MIN CHARGE X4304 CDM 440 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price X4304 SPEECH LANG TREATMENT PER 30 MIN CHARGE X4304 CDM 440 RC facility both 207 207 Gross Charge Type: NIHD_Hosp_Profee_Price X4310 SGD PER VISIT CHARGE X4310 CDM 440 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price X4310 SGD PER VISIT CHARGE X4310 CDM 440 RC facility both 406 406 Gross Charge Type: NIHD_Hosp_Profee_Price Initial OB MediCal Z1032 CDM 521 RC Z1032 HCPCS facility both 367 367 Gross Charge Type: NIHD_Clinic_Price Antepartum visit medi-cal/managed care Z1034 CDM 521 RC Z1034 HCPCS facility both 216 216 Gross Charge Type: NIHD_Clinic_Price Postpartum Visit Medi-Cal Z1038 CDM 521 RC Z1038 HCPCS facility both 216 216 Gross Charge Type: NIHD_Clinic_Price Respiratory Infections And Inflammations With Mcc 177 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 14484 other 14484 14484 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bronchitis And Asthma Without Cc/Mcc 203 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 21193 other 21193 21193 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Congenital And Valvular Disorders Without Mcc 307 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 36210 other 36210 36210 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Cc 378 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 14484 other 14484 14484 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Cc 386 MS-DRG facility inpatient Bc Managed Care Medi-Cal Medicaid Managed Care Plan 84 15527 percent of total billed charges 15527 15527 "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc" 641 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 7242 other 7242 7242 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc 787 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 14484 other 14484 14484 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization Without Cc/Mcc 788 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 14484 other 14484 14484 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Mcc 805 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 7242 other 7242 7242 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Cc 806 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 7242 other 7242 7242 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc 807 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 7242 other 7242 7242 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 871 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 14484 other 14484 14484 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc" 897 MS-DRG facility inpatient Chw Medicaid Managed Care Plan "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements." 14484 other 14484 14484 "Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."