487 PROFESSIONAL FEES
ABDOMINAL PARANCENTESIS 246.00
AGE 1-4 NEW/EX TEN VISIT 120.00
AGE 5-11 NEW/EXTEN VISIT 120.00
AGES 1-4 ESTBL. PT. 95.00
AGES 12-20 ESTBL PT. 95.00
AGES 12-20 NEW/EXTEN VISI 120.00
AGES 5-11 ESTB PT. 95.00
AMPUTATION TOE 807.00
ANKLE SPLINT INIT. APPLIC 400.00
ANOSCOPY, INITIAL 633.00
ARTERIAL PUNCTURE 66.00
ARTHROCENTESIS/MAJOR JOIN 141.00
ARTHROCENTESIS/SMALL JOIN 141.00
AVULSION OF NAIL PART/COM 144.00
BACK STRAPPING 102.00
BIOPSY, DEEP CERVICAL 843.00
BIOPSY, DEEP, AXILLARY 957.00
BIOPSY, DEEP, MAMMARY 1,173.00
BIOPSY, ENDOMETRIAL/CERV. 375.00
BIOPSY LYMPH NODE SUPERF 543.00
BIOPSY, NEEDLE, ABDOMINAL 426.00
BIOPSY, NEEDLE, BRONCHI 870.00
BIOPSY, NEEDLE, LUNG 456.00
BIOPSY, NEEDLE, BREAST MASS 330.00
BIRTH-11MTHS ESTB. PT. 95.00
BONE MARROW NEEDLE BIOPSY 450.00
BRIEF, R.N. 70.00
BRONCH W/BX 819.00
BRTH-11MTH NEW/EXTEN VISI 120.00
BURN/DEBRIDEMENT ADD/10% 132.00
BURN/DEBRIDEMENT TO 10% 132.00
BURN/DRESSING DEBRID. LG 324.00
BURN/DRG/DEB., LG 324.00
BURN/DRG/DEB., SM 126.00
BURN/INIT. TREAT/LOCAL 126.00
CARDIOPULOARY RESUC. 669.00
CLOSED REDUCTION RADIAL 552.00
COLPOCENTESIS 279.00
CONSULTATION- INPATIENT 180.00
CONTROL NASAL HEMOR-COMPL 282.00
CONTROL NASAL HEMOR-POSTE 510.00
CONTROL NASAl HEMOR-SIMPL 216.00
CRlCOTHYROIDOSTOMY 1,056.00
D&C 741.00
DEBRIDEMENT OF SKIN 185.00
DIGITAL BLOCK 68.00
EKG INTERPRETATION 70.00
ELECTROCAUTERY OF LESION 280.00
ENDOSCOPY 750.00
ENDOTRACHEIU. INTUBATION 372.00
ER PHY. AFTER HOURS 35.00
ER PHY. BRIEF EXAM 80.00
ER PHY. COMPREHENSIVE EXA 250.00
ER PHY. COMPREHENSIVE EXA 250.00
ER PHY. EXAM/PROlONGED 246.00
ER PHY. EXTENDED EXAM 220.00
ER PHY. INTERMEDIATE EXAM 180.00
EVACUATE. SUBUNGUAL HEMAT 105.00
EXCIS. LIPOMA - EXTREMITY 930.00
EXCIS. NEOPLASM, LABIA 2,148.00
EXCIS. PILONIDAL CYST 1,680.00
EXCISION BIOPSY EYELID 190.00
EXCISION CYSTIC MASS 243.00
EXCISION OF BREAST LIPOMA 1,017.00
EXCISION OF TUMOR 1,050.00
EXCISION OF TUMOR - HAND 1,000.00
EXCISION TUMOR ARM/WRIST 867.00
EXCISION, B. LESION, FACE 228.00
EXCISION, BEN LESION lCM 200.00
EXCISION, BENIGN LESION 135.00
EXTENSOR TENDON REPAIR 1,011.00
FBR - ARM, LOWER 249.00
FBR - ARM, UPPER 249.00
FBR - EAR CANAL 130.00
FBR - ELBOW 2,025.00
FBR - FINGER W/ABSCESS 213.00
FBR - FOOT, INTERTARSAL 1,194.00
FBR - FOOT, SUBCUTANEOUS 370.00
FBR - HAND 801.00
FBR - INTERPHALANGEAL JT. 945.00
FBR - INTRANASAL 180.00
FBR - LEG, UPPER OR KNEE 1,278.00
FBR - METACARPOPHALANGEAL 1,020.00
FBR - MOUTH, COMPLICATED 669.00
FBR - MOUTH, SIMPLE 225.00
FBR - MUSCLE 1,866.00
FBR - NOSE, COMPLEX 456.00
FBR - NOSE, SIMPLE 180.00
FBR - PHARNYX 486.00
FBR - SHOULDER, GLENOHUMU 1,782.00
FBR - SIMPLE 150.00
FINGER AMP W/ FLAP 1,323.00
FINGER SPLINT 84.00
GASTRIC INTUBAT ./SPECIMEN 456.00
GASTRIC LAVAGE 135.00
HEARING TEST 40.00
HEMMORROIDECTOMY - LIGAT 267.00
HEMORRHOID - TREATMENT OF 450.00
HOLTER MONITOR 300.00
HOSPITAL DISCHARGE 100.00
HYDRADANETITIS SUPPURATIV 560.00
I & D BREAST 200.00
I & D FACIAL CYST 200.00
I & D FINGER 183.00
I & D FOOT 200.00
I & D HEMORRHOID 200.00
I & D HIP ABCESS 183.00
I & D OF TOE 183.00
I & D TONSILLAR ABCESS 300.00
I & D FISTULOTOMY 633.00
I & D HEMATOMA. SIMPLE 115.00
I & D OF FURUNCLE 300.00
I & D PARONYCHIA 183.00
I & D PERINEAL ABCESS 285.00
I & D PILONIDAL CYST, SIMPL 213.00
I & D SEBACEOUS CYST REMOVA 183.00
I & D SUBCUTANEOUS ABCESS 183.00
I & O BARTHOLIN GLAND/ABCES 279.00
IMMUNIZ. ADMIN. ADDITIONA 12.00
IMMUNIZATION ADMINISTRATI 15.00
INITIAL 155.00
INITIAL HOSP C.ARE 150.00
INITIAL HOSP. CARE H&P 119.00
INITIAL HOSP. CARE H&P 119.00
INJECTION - PROF. FEES 20.00
INSERT CATH. /URINARY 87.00
INSERTION OF HICKMAN 1,311.00
INSERTION OF IV 84.00
INSERTION/SUBCLAVIAN CATH 550.00
INSERTION/TEMP. PACEMAKER 783.00
INTERMEDIATE 115.00
IV THERAPY - 1ST HOUR 75.00
I IV THERAPY - ADD. HOURS 33.00
LAPAROSCOPIC CHOLECYST. 2,493.00
LESION DIAM. 1.0-2.0 CM 104.00
LIGATION INTERNAL JUGULAR 1,450.00
LIMITED 95.00
LONG ARM (UNDER 10 YQA) 180.00
LONG ARM CAST 222.00
LONG ARM SPLINT 180.00
LONG LEG (UNDER 10 YOA) 168.00
LONG LEG CAST 318.00
LONG LEG SPLINT 168.00
LUMBAR TAP/DIAG. 300.00
MANIPULATION SHOULDER 582.00
MANIPULATIVE METACARPAL Y 654.00
MEDICAL DATA VISIT 11.00
MEDICAL SCREENING 20.00
NEW PATIENT - COMPREHEN. 170.00
NEW PATIENT - EXTENDED 140.00
NEW PATIENT BRIEF CLINIC 50.00
NEW PT. LIMITED CLINIC 90.00
NURSING CHARGE 86.00
NURSING SERVICE 60.00
OBSERVATION CARE 30.00
OBSERVATION CARE DISCHARGE 100.00
OPEN FX/DISTAL PHALANX 639.00
OPEN TREATMENT/FINGER 873.00
OTOPLASTY PROTRUDING EAR 2,000.00
PELVIC EXAM 50.00
PELVIC EXAM 120.00
PERICARDIOCENTESIS 1,000.00
PHALANGEAL FX -CLOSED 780.00
PHYS EXAM SNF COMPlICATIO 75.00
PHYS. DISCH. - SNF PATIEN 60.00
PHYS. EXAM - ESTAB SNF PT 60.00
PHYS. EXAM - NEW SNF PT. 85.00
PHYS. EXAM SNF MINOR COMP 70.00
PHYS. TRANSFER/ADMIT 250.00
PRE - NEW AGE 40-64 120.00
PRE - NEW AGE 65+ 120.00
PRE-EST AGE 18-39 95.00
PRE-EST AGE 40-64 95.00
PRE-EST AGE 65+ 95.00
PRE-NEW AGE 18-39 120.00
PROF FEES ESTAB PT COMPRE 150.00
PROF FEES ESTAB PT EXTEND 130.00
PROF FEES ESTAB PT INTERM 110.00
PROF FEES ESTAB PT LIMIT 90.00
PROF FEES ESTAB PT LIMIT 60.00
PROF FEES NEW PATIENT 125.00
PROF. FEES LIMITED EXAM 150.00
PROTOSIGMOIDOSOPY 165.00
RE-INSERT GASTRIC TUBE 98.00
REDUCE DISLOC. FINGER/TOE 150.00
REDUCE DISLOC. TIB/FIBULA 200.00
REDUCE DISLOC. /ELBOW 768.00
REDUCE DISLOC. /PATELLA 636.00
REDUCE DISLOC. /SHOULDER 633.00
REMOVAL CERUMEN IMPACTION 150.00
REMOVAL CYST. MASS EAR 200.00
REMOVAL CYST. MASS THIGH 1,209.00
REMOVE CONJUNC. FOR. BODY 150.00
REMOVE CONTRA. DEVICE 150.00
REMOVE CORNEAL FOR. BODY 150.00
REMOVE FECAL IMPACTION 315.00
REMOVE MAG. LESION - HEAD 140.00
REPAIR - INGUINAL HERNIA 1,400.00
REPAIR - VENTRAL HERNIA 1,983.00
REPAIR EXT. TENDON FINGER 1,551.00
REPAIR RICHTER'S HERNIA 2,400.00
REPAIR TENDON WRIST 1,734.00
REPAIR VENTRAL HERNIA 2,400.00
RHYTHM INTERP. STRIP MON. 50.00
SHORT ARM (UNDER 10 YQA) 51.00
SHORT ARM CAST 183.00
SHORT ARM SPLINT 123.00
SHORT LEG (UNDER 10 YQA) 159.00
SHORT LEG CAST 219.00
SHORT LEG SPLINT 159.00
SHOULDER STRAPPING 123.00
SKIN BN DESTROY.6-1CMFACE 79.00
SKIN BN DESTROY.6-1CMLIMB 69.00
SKIN BN DESTROY0-.5CMFACE 59.00
SKIN BN DESTROY0-.5CMLIMB 49.00
SKIN BN DESTROY1-2CMFACE 99.00
SKIN BN DESTROY1-2CMLIMB 89.00
SKIN CA DESTROY.6-1CMFACE 170.00
SKIN CA DESTROY.G-1CMLIMB 131.00
SKIN CA DESTROY0-.5CMFACE 141.00
SKIN CA DESTROY0-.5CMLIMB 97.00
SKIN CA DESTROY1-2CMFACE 199.00
SKIN CA DESTROY1-2CMLIMB 161.00
SNELLEN EYE TEST 3-7 YRS 40.00
SNELLEN EYE TEST 7 YRS + 40.00
SPINAL PUNCTURE 300.00
SUBCUTANEOUS FOR. BODY SIM 68.00
SUBSEQUENT HOSP CARE DETA 120.00
SUBSEQUENT HOSP CARE EXT 90.00
SUBSEQUENT HOSP CARE LTD 80.00
TB SCREENING 20.00
TEMPORO-MANDIBULAR DISLOC 300.00
THORACENTESIS 330.00
TIBIAL SHAFT FRACTURE 350.00
TUBE THORACOSTOMY 774.00
VAGINAL DELIVERY 2,826.00
VENOUS CUTDOWN/OVER 1 YOA 108.00
VERICOSE VEIN INJ. MULTIP 216.00
VERICOSE VEIN INJ. SINGLE 150.00
WART REMOVAL SINGLE LESIO 105.00
WART REMOVEL 2-4 LESIONS 150.00
WOUND REPAIR 12.6-20.0 CM 477.00
WOUND REPAIR 12.6-20.0 CM 678.00
WOUND REPAIR 12.6-20.0 CM 675.00
WOUND REPAIR 12.6-20.0 CM 798. 000
WOUND REPAIR 2.6 - 5.0 CM 321.00
WOUND REPAIR 2.6 - 5.0 CM 528.00
WOUND REPAIR 2.6 - 7.5 CM 264.00
WOUND REPAIR 2.6 - 7.5 CM 423.00
WOUND REPAIR 2.6 - 7.5 CM 426.00
WOUND REPAIR 5.0-7.5 CM 390.00
WOUND REPAIR 5.0-7.5 CM 612.00
WOUND REPAIR 7.6-12.5 CM 366.00
WOUND REPAIR 7.6-12.5 CM 525.00
WOUND REPAIR 7.6-12.5 CM 534.00
WOUND REPAIR 7.6-12.5 CM 522.00
WOUND REPAIR 7.6-12. 5 CM 798.00
WOUND REPAIR UP TO 2.5 CM 219.00
WOUND REPAIR UP TO 2.5 CM 252.00
WOUND REPAIR UP TO 2.5 CM 163.00
WOUND REPAIR UP TO 2.5 CM . 330.00
WOUND REPAIR UP TO 2.5 CM 163.00
Dos Palos Memorial Hospital Clinic
25 Commonly Charged Services
1 487905C Physician Charge Limited $ 90.00
2 487907C Physician Charge Intermediate $ 110.00
3 4875023 Physician Charge Extended $ 130.00
4 4875024 Physician Charge Comprehensive $ 150.00
5 4014006 Clinic Room Charge $ 120.00
6 4637102 Chest (X-Ray) $ 213.00
7 4637361 Ankle Complete (X-Ray) $ 194.00
8 4637357 Knee Complete (X-Ray) $ 260.00
9 4637211 Lumbar Complete (X-Ray) $ 351.00
10 4637321 Wrist (X-Ray) $ 200.00
11 4508109 Dip Stick Urinalysis $ 19.00
12 4508299 Urine Pregnancy Test $ 50.00
13 4508602 Lab Handling Charge (Blood) $ 36.00
14 4470093 Fingerstick - Blood Sugar $ 20.00
15 4472132 Fingerstick - Hemoglobin $ 10.00
16 4590001 EKG $ 130.00
17 4470247 Pulse Oximeter $ 32.00
18 4871217 Wound Repair (Simple) $ 219.00
19 4871278 Incision & Drainage -Toe $ 183.00
20 4871006 Incision & Drainage - Abscess $ 183.00
21 4871307 Snellen Eye Test $ 40.00
22 4871309 Audiometric Testing (Hearing) $ 40.00
23 4871310 TB Screening $ 121.00
24 4470283 Nebulizer Treatment $ 54.00
25 4871293 Ear Lavage $ 150.00
revised 06/06/06
471 PHARMACY/IV THERAPY
ACETAMETAPHEN LIQUID 3.00 DARVON TABLET
ACETAMETAPHEN TABLET 3.00 DECADRON INJ 4mg/ml
ACTIFED SYRUP 3.00 DEMEROl INJECTION 100MG
ACTIVATED CHARCOAL 3.00 DEMEROL INJECTION 25MG
ADENOCARD INJECTION 75.00 DEMEROL INJECTION 50MG
ALBUMIN 50ml 1/12.5g INJ. 264.00 DEMEROL INJECTION 75MG
ALBUTEROL IMRATION SOL. 4.00 DEPO PROVERA INJ. 150MG
ALBUTEROL SYRUP 3.00 DEXTROSE INJECTION
ALBUTEROL WITH N. S. 4.00 DICLOXYCILLIN TABLET
ALDACTONE TABLET 3.00 DILANTIN INJECTION
ALDOMET INJECTION 20.00 DILANTIN TABLET
ALDOMET TABLET 3.00 DILTIAZ INJECTI
ALTERNAJEL ANTACID 3.00 DlMETAP ELIXIR
ALUPENT SYRUP 3.00 DOBUTREX INJECTI
AMBIEN TABLET 6.00 DONNATOL ELIXIR
AMINOPHYLLINE INJECTION 20.00 DONNATOL TABLET
AMMONIA INHALANT 3.00 DOPAMINE INJECTION
AMOXICILLIN LIQUID 3.00 DOXYCYCLINE INJECTION
AMOXICILLIN TABLET 3.00 DOXYCYCLINE TAB
AMPICILLIN 125 mg INJ. 20.00 DTP-Hib COMBO VAC.
AMPICILLIN 25O mg INJ. 20.00 DTaP - VACCINE
AMPICILLIN INJECTION 1 GM 20.00 DULCOLAX SUPPOSITORY
AMICILLIN SUSPENSION 3.00 DULCOLAX TABLET
AMPICILLIN TABLET 3.00 EMLA IV CREAM
ANCEF INJ. 1GM 10 ml VIAL 20.00 ENULOSE
ANTIVERT TABLET 3.00 EPINEPHRlNE (CODE) INJ.
APRESOLINE INJECTION 20.00 EPINEPHRINE INJ 1mg/ml
AQUA MEPHYTON INJ 10mg/ml 20.00 EPOGEN INJECTION
ASCORBIC ACID 3.00 ERYTHROMYCIN INJ 1gm
ASCRIPTIN TABLET 3.00 ERYTHROMYCIN OINTMENT
ASPIRIN SUPPOSITORY 3.00 ERYTHROMYCIN TABLET
ASPIRIN TABLET 3.00 ESTROGEN INJECTION
ATARAX SYRUP 3.00 ETHYL CHLORIDE SPRAY
ATENOLOL TABLET 3.00 FERROUS GLUCONATE LIQUID
ATIVAN INJECTION 20.00 FERROUS SULFATE TABLET
ATIVAN TABLET 3.00 FESO4 LIQUID
ATROPINE INJECTION 0.4mg 20.00 FIBERCON I
ATROPINE SULPHATE 1.0mg 20.00 FLAGYL INJECTION ~
ATROVENT SOLUTION 4.00 FLAGYL TAB
AUGMENTIN SUSPENSION 12.00 FLEXERIL TABLET
AURALGEN EAR DROPS 9.00 FOLATE INJECTION
AZITHROMYCIN TABLET 3.00 FOLIC ACID INJECTION
B-6 TABLET 3.00 FORTAZ 1gm INJECTION
BACTRIM TABLET 3.00 FORTEZ IV
BENADRYL ELIXER 3.00 FU5 INJECTION
BENADRYL INJ 50 mg 20.00 GARAMYCIN INJECTION
BENADRYL TABLET 3.00 GARAMYCIN OPTH. OINTMENT
BENEMID TABLET 3.00 GENTAMYCIN INJECTION
5.00 GLUCAGON INJECTION lmg/m1 20.00
20.00 GLYCERIN OPTH. OINTMENT 3.00
20.00 GLYCERIN SUPPOSITORY 3.00
20.00 H202 LIQUID 3.00
20.00 HALCION TABLET 3.00
20.00 HALDOL INJECTION 5MG 20.00
98.00 HALDOL TABLET 5.00
20.00 HALLEY'S M.D. LIQUID 3.00
3.00 HEPARIN INJ 5000 UNITS/ml 20.00
20.00 HEPATITIS A 10.00
3.00 HEPATITIS B VACCINE 0.5ml 117.00
20.00 HEPLOCK SOL. INJ 100U/ml 20.00
3.00 HUMAN ALBUMIN SERUM 230.00
111.00 HYDROCORTISONE CREAM 6.00
3.00 HYDRODIURIL TABLET 3.00
3.00 HYDROXYZINE INJECTION 20.00
20.00 HYDROXYZINE TABLET 3.00
20.00 Hib-VACCINE 10.00
3.00 IBUPROFEN TABLET 3.00
10.00 IMITREX INJECTION 117.00
10.00 IMMODIUM P.O. 3.00
3.00 INAPSINE/CC INJECTION 20.00
3.00 INASPINE INJECTION 30.00
5.00 INDERAL INJECTION 20.00
3.00 INDEROL TABLET 3.00
20.00 INDOCIN TABLET 3.00
20.00 INFED INJECTION 64.00
294.00 INFLUENZA VAC. - PEDI 10.00
20.00 INFLUENZA VACCINE 0.5ml 15.00
9.00 INSULIN HUMELIN NPH INJ. 20.00
3.00 INTROPIN INJECTION 20.00
20.00 IPECAC SYRUP 3.00
3.00 IPV-lNACT. POLIO VACCINE 10.00
3.00 IRON DEXTRAN INJECTION 81.00
3.00 ISOPROTERENOL INJECTION 20.00
3.00 ISOVUE INJECTION 48.00
3.00 IV PIGGY BACK SOLUTION 14.00
75.00 IV SOLUTION 1000cc 20.00
6.00 IV SOLUTION 250cc 20.00
3.00 IV SOLUTION 500 ml 20.00
20.00 IV SOLUTION 50cc 15.00
20.00 K-DUR TABLET 3.00
37.00 K-PHOS TABLET 3.00
20.00 KAOPECTATE LIQUID 3.00
20.00 KCL OR K+ LIQUID 3.00
20.00 KEFLEX SUSPENSION 3.00
9.00 KEFLEX TABLET 3.00
20.00 KENALOG 40 INJECTION 39.00
LABETALlOL INJECTION 21.00 NITROSTAT OINTMENT
LABETALOL TABLET 3.00 NITROSTAT TABLET
LANOXIN INJ 0.25 mg/ml 20.00 NORMAL SALINE 0.9%
LANOXIN TABLET 3.00 NORMAL SALINE INJECTION
LASIX INJECTION 20.00 NOROXIN TABLET
LASIX TABLET 3.00 NUBAIN INJECTION
LEUCOVARIN INJECTION 86.00 NUBAIN INJECTION
LEVOPHED CODE INJECTION 30.00 NYSTATIN TOPICAL
LEVOPHED INJECTION 20.00 OPTHAINE OPTH. DROPS
LIBRIUM INJECTION 20.00 OPTIRAY
LIBRIUM TABLET 5.00 ORGANIDIN TABLET
LIDOCAINE 1% INJECTION 20.00 OXACILLEN INJECTION 2GM
LIDOCAINE 20% INJ. 2GM 20.00 PAPAVERINE INJECTION
LIDOCAINE IV INFUSION 20.00 PARAFON FORTE TABLET
LORAZEPAM INJECTION 13.00 PEDIAPRED LIQUID 5cc's
LORAZEPAM TABLET 3.00 PEDIAZOLE LIQUID
LOTENSIN TABLET 3.00 PEDIPROFEN LIQUID
LOVENOX INJECTION 40.00 PENICILLIN B INJECTION
MAG CITRATE LIQUID 3.00 PENICILLIN INJ. 5,000,000
MAG SULFATE 50% INJECTION 20.00 PENICILLIN POTASSIUM TAB.
MANNITOL INJECTION 20.00 PENICILLIN VK 125MB LIG.
MARCAINE INJECTION 0.25% 21.00 PENICILLIN VK 250MG LIG.
MEASLES - VACCINE 10.00 PENICILLIN VK 250MG TAB.
METHERGINE INJECTION 20.00 PEPCID TABLET
METOCLOPRAMIDE INJECTION 20.00 PHENERGAN COEDINE SYRUP
MILK OF MAGNESIA 3.00 PHENERGAN INJECTION 25MG
MMR-MEASLES, MMPS, RUBELLA 10.00 PHENERGAN INJECTION 50MG
MORPHINE SULF.INJ. 10MG/ML 13.00 PHENERGAN LIQUID
MOTRIN TABLET 3.00 PHENERGAN SUPPOSITORY
MUCOMYST INHAL. SOLUTION 8.00 PHENERGAN TABLET
MULTI VITAMIN INJECTION 20.00 PHENOBARBITAL INJ 130mg/m
MULTI VITAMIN LIQUID 3.00 PHENOBARBITAL TABLET
MULTI VITAMIN TABLET 3.00 PHYSOSTIGMINE INJECTION
MULTI-VITAMIN INJECTION 20.00 PIPRACIL INJECTION
MYLANTA/MAALOX LIQUID 3.00 PITOCIN INJECTION
NALDECOM LIQUID 3.00 PNEUMOCOCCAL VAC 0.5ml
NALDELATE LIQUID 3.00 PODOCON 25 TOPICAL
NAPROXEN TAB 3.00 POLIO ORAL DISPETTES
NARCAN INJECTION 0.4mg/ml 20.00 POTASSIUM CHLORIDE SOLU.
NEOMYCIN IRRIGATION 29.00 POTASSIUM INJECTION
NEOSPORIN OPTH. OINTMENT 9.00 PREDISONE TABLET
NEOSPORIN TOPICAl OINTMENT 3.00 PREVNAR
NEUPOGEN INJECTION 420.00 PRIMAXIN INJECTION
NIACIN INJECTION 20.00 PRINIVIL TABLET
NITROBID OINTMENT 6.00 PROCARDIA TABLET
NITROGLYCERIN INJECTION 20.00 PROCIANOMIDE 1000MG INJ.
NITROGLYCERIN TABLET 3.00 PROCIANOMIDE 500MG INJ.
NITROPRESSIDE SOD. INJECT 20.00 PRONESTYL INJ 500mg/ml
10.00 PROVENTIL WITH N.S. 4.00
3.00 PSEUDOPHED SYRUP 3.00
1.00 PYREDOXINE HCL INJECTION 20.00
20.00 PYRIDIUM TABLET 3.00
6.00 QUINSANA POWDER 6.00
20.00 RABIES VACCINE 75.00
20.00 REGLAN TAB 3.00
5.00 RHOGAM INJECTION 52.00
5.00 ROBAXIN TABLET 3.00
48.00 ROBITU5SIN DM SYRUP 1GM 3.00
3.00 ROCEPHIN INJECTION 1GM 118.00
20.00 ROCEPHIN INJECTION 1GM 118.00
20.00 ROMAZICON 81.00
3.00 RUBELLA - VACCINE 10.00
3.00 RUGBY EAR DROPS 9.00
3.00 SAF-GEL 3.00
3.00 SEPTRA SUSPENSION 3.00
20.00 SEPTRA-BACTRIM TABLET 3.00
20.00 SILVADENE OINTMENT (LG) 9.00
3.00 SILVADENE OINTMENT (SM) 6.00
3.00 SLO-BID TABLET 3.00
3.00 SNAKE ANTIVENUM INJECTION 20.00
3.00 SNF PHARMACY 50.00
3.00 SODIUM BICARB. INJECTION 20.00
3.00 SODIUM CHLORIDE INJECTION 20.00
20.00 SOLU CORTEF INJ. 100MG 20.00
20.00 SOLU MEDROL INJECT. 100MG 20.00
3.00 SOLU MEDROL INJECT. 5OOMG 20.00
6.00 SPIDER ANTIVENUM INJECT. 64.00
3.00 STADOL INJECTION 2mg 20.00
20.00 STREPTOKINASE INJECTION 970.00
3.00 SUCCINYLCHOLINE INJ. 20mg 20.00
20.00 SUDAFED 3.00
25.00 SUDAMYD OPTH. OINTMENT 9.00
20.00 SULFACETAMIDE OPTH. SOL. 5.00
13.00 SUSPHRINE INJECTION 20.00
50.00 TAGAMENT INJECTION 20.00
10.00 TAGAMENT TABLET 3.00
3.00 TALWIN INJECTION 20.00
20.00 TALWIN TABLET 3.00
3.00 TENORMIN INJECTION 20.00
10.00 TENORMIN TAB 25 MG. 3.00
60.00 TESSLON PERLES TABLET 3.00
3.00 TESTOSTERONE INJECTION 20.00
3.00 TETANUS DIPTHERIA INJ. 20.00
20.00 TETANUS IMMUNE INJECTION 110.00
20.00 TETANUS TOXOID 5ml - PEDI 20.00
20.00 TETANUS TOXOID INJ 5ml 20.00
TETRACYCLINE TABLET 3.00
THEODUR TABLET 3.00
THEOPHYLLINE ELIXIR 3.00
THEOPHYLLINE INJ. 250MG 20.00
THERAGRAN-M TABLET 3.00
THIAMINE INJECTION 13.00
TICARCILLIN INJECTION 20.00
TICARCILLIN INJECTION 1GM 25.00
TIGAN ADULT SUPPOSITORY 3.00
TIGAN PEDI SUPPOSITORY 3.00
TORADOL INJECTION 2ML 23.00
TORADOL TABLET 5.00
TRANDOTE INJECTION 20.00
TRIAMCINOLONE INJ. 40mg/m 20.00
TRIAMINICOL LIQUID 3.00
TUBERCULIN TEST 20.00
TYLENOL ELIXIR/tsp. 3.00
TYLENOL SUPPOSITORY 120MG 3.00
TYLENOL SUPPOSITORY 650MG 3.00
TYLENOL TABLET 3.00
TYLENOL/CODIENE TABLET 5.00
VALIUM INJECTION 5mg 20.00
VALIUM TABLET 5.00
VANCOMYCIN INJECTION 25.00
VAPONEPHRINE W/ N.S. 4.00
VARICELLA-CHICKEN POX VAC 10.00
VASOPRESSIN INJECTION 47.00
VENTALIN INHALATION SOLU. 3.00
VENTOLIN SYRUP 3.00
VERAPAMIL INJECTION 20.00
VERSED INJECTION 25.00
VICODEN TABLET 5.00
VISTARIL INJECTION 50MG 20.00
VISTARIL TABLET 3.00
VITAMIN B-12 INJECTION 20.00
VITAMIN B-6 INJECTION 20.00
VITAMIN C TABLET 3.00
XANAX TABLET 3.00
XANTAX TABLET 3.00
XYLOCAINE 1% INJECTION 20.00
XYLOCAINE 1%WI EPI. INJ. 20.00
XYLOCAINE 2% WI EPI. INJ. 20.00
XYLOCAINE INJECTION 100MG 20.00
XYLOCAINE INJECTION 2GM 20.00
XYLOCAINE TOPICAL 4% 3.00
XYLOCAINE VISCOUS LIQUID 3.00
ZANTAC INJECTION 20.00
ZANTAC TABlET 3.00
ZINCFRIN EYE DROPS 3.00
ZITHROMAX 1GM 50.00
ZITHROMAX 500M 70.00
ZITHROMAX LIQUID 48.00
ZITTHROMAX TABLET 15.00
463 RADIOLOGY
A-C JOINTS 230.00 FOREARM
ABDOMEN (2 VIEWS) 201.00 FOREARM (BILATERAL)
ABDOMEN (KUB) 154.00 FOREARM (COMPARISON)
ABDOMEN COMPLETE 288.00 GALLBLADDER IV INFUSION
ABDOMINAL COMPLETE - U/S 225.00 GALLBLADDER REPEAT
ABDOMINAl LIMITED - U/S 125.00 GALLBLADDER ROUTINE
ADDITIONAl FILM/COMPlIMEN 50.00 GUIDANCE ABSCESS DRAIN US
ANKLE (BILATERAL) 287.00 GUIDANCE AMNIOCENTESIS US
ANKLE (COMPARISON) 93.00 GUIDANCE BIOPSY - U/SOUND
ANKLE COMPlETE 194.00 GUIDANCE CYST ASPIR. -U/S
ANKlE LIMITED 144.00 GUIDANCE THORACENTESIS US
BARIUM ENEMA 360.00 HAND
BARIUM ENEMA WITH AIR 470.00 HAND (BILATERAL)
BONE AGE SURVEY 245.00 HAND (COMPARISON)
BONE LENGTH STUDY 423.00 HIPS, BILATERAL
BONE SURVEY 622.00 HUMERUS
BREAST - UlTRA-SOUND 54.00 HUMERUS (COMPLETE)
CAROTID - U/S 860.00 ISOVUE INJ. 50ML
CERVICAl (1 VIEW) 211.00 IVP
CERVICAl (2 VIEWS) 188.00 IVP, HYPERTENSIVE
CERVICAl (5 VIEWS) 325.00 KNEE, (BILATERAL)
CERVICAl (7 VIEWS) 387.00 KNEE, (COMPARISON)
CHEST (1 VIEW) 144.00 KNEE COMPLETE
CHEST (2 VIEWS) 213.00 KNEE LIMITED
CHEST (3 VIEWS) 244.00 LOWER LEG ULTRA-SOUND
CHEST (4 VIEWS) 275.00 LUMBAR, COMPLETE
ClAVICAL 173.00 LUMBAR, LIMITED
CLAVICAL (COMPARISON) 88.00 MANDIBLE, COMPLETE
CT OF ABDOMEN 1812.00 MANDIBLE, LIMITED
CT SCAN 952.00 MASTOIDS
CYSTOGRAM 335.00 NASAL BONES
DUPL. OF RADIOGRAPHS 20.00 OBSTETRIC COMPLETE U/S
ELBOW 200.00 OBSTETRIC FOLLOW-UP - U/S
ELBOW (BILATERAl) 301.00 OBSTETRIC LIMITED - U/S
ELBOW (COMPARISON) 101.00 ORBITS & OPTIC FORAMINA
ENTIRE SPINE SURVEY 622.00 OS CALCIS (COMPARISON)
ESOPHAGUS 310.00 OS CALCIS (HEEL)
EYE (FOREIGN BODY) 275.00 PARANASAL SINUSES
FACIAl BONES 275.00 PELVIC COMPLETE - U/S
FEET (BILATERAl) 285.00 PELVIC LIMITED - U/SOUND
FEMUR 200.00 PELVIMETRY
FEMUR (COMPARISON) 101.00 PELVIS & LATERAL HIP
FETOGRAM 198.00 PELVIS W/FROG-LEG
FINGERS 148.00 PELVIS, AP
FINGERS (COMPARISON) 75.00 PORTABLE MACHINE PROCEDUR
FOOT (COMPARISON) 91.00 RETROPERITONEAL COMP. U/S
FOOT COMPlETE 194.00 RETROPERITONEAL LIMIT. U/S
FOOT LIMITED 148.00 RIBS, BILATERAL
173.00 RIBS, UNILATERAL 256.00
249.00 SACROLIAC JOINTS 229.00
76.00 SACRUM & COCYX 224.00
284.00 SALI VARY GLANDS 228.00
169.00 SCAPULA 211.00
325.00 SCAPULA (COMPARISON) 46.00
190.00 SCOLIOSIS STUDY 140.00
190.00 SCROTUM & CONTENTS - U/S 150.00
140.00 SCROTUM ULTRASOUND 135.00
140.00 SELLA TURSICA 224.00
140.00 SHOULDER (BILATERAL) 316.00
194.00 SHOULDER (COMPARISON) 92.00
294.00 SHOULDER, COMPLETE 224.00
100.00 SHOULDER, LIMITED 185.00
300.00 SKULL (LIMITED) 187.00
172.00 SKULL SERIES 293.00
88.00 SMALL BOWEL SERIES 170.00
150.00 SOFT TISSUE NECK 131.00
445.00 STERNOCLAVICULAR JOINT 211.00
275.00 STERNUM 236.00
361.00 THORACIC SPINE 336.00
101.00 THORACOLUMBAR JUNCTION 217.00
260.00 THYROID - ULTRA-SOUND 155.00
141.00 TIBIA/FIBULA 188.00
1031.00 TIBIA/FIBULA (COMPARISON) 94.00
351.00 TMJ'S 304.00
313.00 TOES 135.00
269.00 TOES (COMPARISON) 66.00
223.00 UPPER G. I. 375.00
438.00 UPPER G. I. W/SM BOWEL F/O 450.00
256.00 WRIST 200.00
180.00 WRIST (BILATERAL) 291.00
150.00 WRIST (COMPARISON) 91.00
135.00 XRAY CALL BACK 62.00
273.00
66.00
130.00
293.00
180.00
135.00
388.00
230.00
254.00
198.00
62.00
180.00
135.00
310.00
MISC. CHARGES
CLINIC ROOM 120.00
DMV PHYSICAL 109.00
NURSING CHARGE 86.00
ACUTE ROOM AND BOARD 500.00
AMBULANCE TRANSPORT 1,400.00
EKG 130.00
CARDIAC MONITOR (3 ELEC) 66.00
CARDIAC MONITOR (STRIP) 50.00
CARDIAC MONITOR/HOUR 80.00
OBSERVATION/HOUR 40.00
COLIN MONITOR/HOUR 50.00
LAB HANDLING FEE 23.00
PREGNANCY TEST 50.00
URINALYSIS - CHEMICAL 19.00
VENI PUNCTURE 13.00
LAB BLOOD HANDLING FEE 36.00
479 OCCUPATIONAL THERAPY
ADL EQUIPMENT 10.00
AIR PUTTY 15.00
CONFERENCE & REPORT - 30MIN 48.00
CONFERENCE/RPT -ADD 15MINS 48.00
CONSULTATION & REPORT 48.00
DRESSING STICK 27" 9.00
FORK - GOOD GRIP 15.00
FORK - WEIGHTED 16.00
HAND SPLINT EQUIPMENT 76.00
INITIAL EVALUATION 173.00
KNIFE - WEIGHTED 16.00
O. T. EVALUATION 173.00
O. T. EVALUATION, 30 MIN. 260.00
ORTHO FIT/TRAIN-15 MINS 48.00
PALM CONE 28.00
PALM GRIP 12.00
PEN - WEIGHTED 30.00
PEN REFILL 3.00
PLASTIC SHOEHORN W/HOOK 6.00
PROSTHETIC TRAINING-l5MIN 48.00
RE-EVALUATION 173.00
RE-EVALUATION ADD 15MINS 72.00
REACHER 32" LENGTH 54.00
SELFCARE TRAINING 15 48.00
MIN SLING - CUSTOM MADE 28.00
SOCK AIDE, EASY PULL 33.00
SPLINT - CUSTOM MADE 21.00
SPOON - GOOD GRIP 15.00
SPOON - WEIGHTED 16.00
THERAPEUTIC EXERCISE-15M 48.00
THERAPEUTIC PROCEDURE-15M 48.00
THERAPY PUTTY 6.00
TREATMENT-ADD 15 MINS 44.00
TREATMENT-INITIAL 30 MINS 87.00
UNIVERSAL CUFF 18.00
WHEELCHAIR TRAINING-l5MIN 72.00
477 PHYSICAL THERAPY
GAIT TRAINING 55.00
HIGH REHAB LEVEL 108.00
LOW REHAB LEVEL 15.00
MANUAL TECHNIQUE 100.00
MEDIUM REHAB LEVEL 50.00
NEUROMUSCULAR REEDUCATION 60.00
P.T. ACTIVITY 50.00
P.T. EVALUATION 140.00
PHYSICAL THERAPY 0.00
SELF CARE/HOME TRAINING 65.00
SWALLOWING EVALUATION 96.00
SWALLOWING TREATMENT 140.00
THERAPEUTIC EXERCISES 52.00
U. H. REHAB LEVEL 227.00
V. H. REHAB LEVEL 158.00
472 THERAPY
"T" ADAPTOR 3.00
02 SAT ANALYSIS CONT /HR 42.00
02 SATURATION ANALYSIS 57.00
02 SET UP 38.00
AEROCHAMBER 31.00
AEROCHAMBER - 2 45.00
AEROSOL DAILY SERV. CHARG 44.00
AEROSOL MASK 14.00
AEROSOL NEBULIZER MASK 13.00
AEROSOL NEBULIZER SET UP 54.00
AMBULATE PATIENT WITH 02 66.00
BACTERIA FILTER 34.00
CHEST PHYSIOTHERAPY 36.00
CONNECTING TUBING 20.00
COOL AEROSOL CHARGE/HOUR 24.00
DISP. AMBU BAG MASK 28.00
DISP. IPPB MASK 24.00
ELBOW ADAPTOR 3.00
FACE TENT 20.00
H2O TRAP 22.00
HAND HELD NEB. TREATMENT 45.00
HAND HELD NEBULIZER CIR. 18.00
HEATED AEROSOL DAILY CHAR 45.00
HEATED AEROSOL SETUP 56.00
HHN SETUP W/ AEROSOL MASK 30.00
I. S. RX 36.00
I. S. SET UP 34.00
IPPB MANIFOLD 98.00
IPPB TREATMENT 67.00
LG BORE CORRUGATED TUBING 24.00
MDI INSTRUCT 67.00
MDI TREATMENT 11.00
MEDICATION AND SALINE 7.00
MIST TENT DAILY CHARGE 60.00
MIST TENT HOURLY CHARGE 15.00
MIST TENT SET -UP CANOPY 100.00
MOUTH SEAL 24.00
NON REBREATHING MASK 28.00
NOSE CLIP 3.00
02 HUMIDIFIER 6.00
ONE WAY VALVE 5.00
OXYGEN CANNULA 13.00
OXYGEN MASK, SIMPLE 13.00
OXYGEN PER DAY 42.00
OXYGEN PER HOUR 18.00
OXYGEN VENTIMASK 13.00
PATIENT /FAMILY INSTRUCTIO 28.00
PEAK FLOW METER SETUP 71.00
PEAK FLOW TREATMENT 24.00
POSTURAL DRAINAGE 49.00
PULMONARY FUNCTION SPIROM 148.00
RESP ARREST 1ST HOUR 103.00
RESP ARREST X 30 MINUTES 144.00
RESPIRATORY ASSESS/SCREEN 71.00
RESUSCITATOR BAG SET UP 74.00
SET UP BAGS 1.00
SPUTUM INDUCTION 20.00
SUCTION 18.00
SUCTION DAILY SERV CHARGE 20.00
SUCTION INITIAL. S/U 28.00
SUCTION KIT 24.00
SUCTION SETUP STANDBY 24H 18.00
SUCTION YANKHAUR 9.00
TECH SPEC/15 MINUTES 36.00
VAPONFRIN 3.00
447 CENTRAL SUPPLY
2X2/2X3 DRESSING 3.00 CATHETER (STRAIGHT)
4X 4 DRESSING 11.00 CATHETER (TEX. CON. TUBE)
ABD PADS 10.00 CATHETER (TEXAS)
ABDOMINAL BINDER 50.00 CATHETER (UMBILICAL)
ABG KIT 6.00 CATHETER CONNECT TUBE
ACE BANDAGE 2 INCH 6.00 CATHETER DRAIN BAG
ACE BANDAGE 3 INCH 7.00 CATHETER PLUG
ACE BANDAGE 4 INCH 8.00 CERVICAL FOAM COLLAR
ACE BANDAGE 6 INCH 10.00 CERVICLE COLLAR SERPENT IN
ADAPTIC STERILE DRESSING 10.00 CHEM-STRIP
ADD-A-CATH TRAY 28.00 CHEST TUBE
ADMIT KIT 10.00 CLAVACLE SUPPORT
ADULT BED PAN AUTOCLAV. 35.00 CLEAN CATCH KIT
AIRWAY (ESOPHAGEAL) 112.00 COLD PACK
AIRWAY (NASOPHARYNGEAL) 18.00 COLIN MONITOR PER HOUR
AIRWAY (PLASTIC) 9.00 COLOSTOMY POUCH
AMBULANCE TRAVEL 200.00 COLOSTOMY WAFER
AMNIOTIC HOOK 6.00 CONFORM GAUZE
ANGIOCATH 14.00 CONNECTOR 5 IN 1
ANKLE WRAP FIGURE EIGHT 35.00 CONTINUOUS OVERHEAD IRRIG
ANKLE WRAP SUPPORT DELUX 35.00 CRASH CART
ANKLET PULLOVER (LIGHT) 57.00 CUTDOWN TRAY
AUDIOMETRY TESTING 12.00 DECUB DRESSING
BABY POWDER 8 OZ. 5.00 DEFIBRILLATOR
BASIC BIOPSY TRAY ,~ 46.00 DENTURE CUP/DISP.
BASIN SET STERILE 9.00 DEODORANT
BED PAN (FRACTURE) 12.00 DERMA BAND TUBE
BED PAN (REGULAR) 7.00 DIAPER (EACH)
BETADINE 4 OZ LIQUID 5.00 DIAPERS/DOZ.
BETADINE JELLY 5.00 DIPSTICK (URINE)
BETADINE PREP TRAY 28.00 DISPOSABLE HUMIDIFIER
BETADINE SCRUB BRUSH 6.00 DISPOSABLE NEEDLE/SYRINGE
BETADINE SWAB (1PACK) 2.00 DOPPLER WITH JELLY
BETADINE SWABS (3 PACK) 5.00 DOUCHE
BLOOD TUBING 11.00 DUODERM
BLOOD Y TUBING 14.00 EAR LAVAGE
BONE MARROW NEEDLE 15.00 EAR TRAY
BONE MARROW TRAY 35.00 EGG CRATE MATTRESS PAD
BOVIE CAUTERIZATION 75.00 ELASTIC KNEE SUPPORT
BOVIE GROUND PADS 22.00 ELASTIC WRIST SUPPORT
BOVIE TIPS (DISPOSABLE) 35.00 ELASTOPLAST TAPE
BRYANT TRACTION (DAILY) 14.00 ELBOW PROTECTORS (PR)
BUTTERFLY (STERI STRIPS) 8.00 ELBOW PROTECTORS EGGCRATE
CAP (O.R.) 3.00 ELECTROCAUTERY PENCIL
CARDIAC MONITOR PADS 10.00 ELECTRODES (MONITOR PADS)
CAST REMOVAL 28.00 EMESIS BASIN (AUTOCLAVE)
CATHETER (FOLEY) 24.00 ENDROTRACHEAL TUBE
CATHETER (ROBINSON) 2.00 ENMA (FLEETS)
16.00 ENMA BUCKET/ENEMA SET 16.00
18.00 ETHYL CHLORIDE 5.00
35.00 EXAM GLOVE (EACH) 2.50
42.00 EXAM GLOVES/BOX 20.00
10.00 EXTENSION TUBING 4.00
11.00 EXTERNAL PACEMAKER PER HR 110.00
5.00 EXUDERM DRESSING 17.00
33.00 EYE LENS - MORGAN IRRIGA. 60.00
44.00 EYE PADS 3.00
2.00 EYE SHIELD (METAL) 6.00
31.00 EYE TRAY 22.00
42.00 FEEDING ADAPTOR 20.00
6.00 FEMININE PADS/DOZ 6.00
6.00 FINGER STICK - MACHINE 20.00
48.00 FINGERSTICK - H & H 10.00
12.00 FISH NET 10.00
15.00 FOLEY CATH TRAY 54.00
7.00 FRACTURE BED PAN (AUTOCLA 35.00
3.00 FULL ARM CAST 50.00
6.00 FULL LEG CAST 57.00
55.00 GASTRIC LAVAGE TRAY 39.00
151.00 GASTROSTOMY TUBE 16.00
12.00 GAUZE TUBE 7.00
86.00 GELFOAM SPONGE 2.00
1.00 GOMCO SUCTION MACHINE 33.00
4.00 GOWN (PATIENT) 3.00
30.00 HEEL PROTECTORS (PAIR) 32.00
2.00 HEEL PROTECTORS EGGCRATE 18.00
24.00 HEMOCUE SUPPLIES 28.00
9.00 HEMOCULT 9.00
10.00 HEMOVAC CLOSED WOUND DRAI 52.00
15.00 HEP-LOCK (MINI-CATH) 16.00
30.00 HEP-LOCK CAP 6.00
17.00 HEP-LOCK INFUSION SET 21.00
12.00 HISTO FREEZE 25.00
20.00 HOT PACK 7.00
22.00 I & 0 HAT 7.00
57.00 ICE PACK 6.00
32.00 INSTRUMENTS (EXTRA) 6.00
32.00 IOBAN DRAPE 70.00
8.00 IODOFOOM GAUZE 13.00
32.00 IRR. SOL. (STERILE WATER) 15.00
18.00 IRRIGATION DRESSING 15.00
25.00 IRRIGATION SUPPLIES 26.00
10.00 IRRIGATION TRAY 10.00
3.00 ISOLATION (DAILY CHARGE) 39.00
25.00 ISOLATION GOWN 8.00
15.00 ISOLATION MASK 3.00
IV ARM BOARD 15.00 NEEDLE & BUTTERFLY NEEDLE
IV CONNECTING LOOP 3.00 NG TUBE (NASOGASTRIC)
IV MCGAW TUBING (ACCRO) 46.00 NGT STRIP
IV PEDI DRIP 7.00 NONCOR INFUSION SET
IV PRIMARY TUBING 13.00 NORMAL SALINE IRRIGATION
IV PUMP (DAILY) 33.00 NOSE PLUG KIT
IV SECONDARY TUBING IV 8.00 NOURISHMENT BAG
IV START PACK 15.00 02 CANNUlA
K PAD (DAILY CHARGE) 20.00 02 MASK
KERLIX ROLLS (STERILE) 8.00 02 NON REBREATHING MASK
KERLIX SPONGES (2 PK) 7.00 OB BELT
KLEENEX / BOX 3.00 OB INSTRUMENT PACK
KLING (ALL SIZES) 7.00 OB PACK
KNEE PADS 10.00 OB PADS (12 PACK)
KNEE SPLINT 165.00 OR DRAPE SHEET - ADDITNL
KNEE SPLINT UNIVERSAL 75.00 OR PREP TRAY
KY JELLY 3.00 PACER PADS
LAP PACK 100.00 PACKED CELLS
LAP SHEET 44.00 PAP KIT
LAP TAPES 5.00 PARACENTENSIS
LECTROVAC (T&A SUCT TIP) 35.00 PEAK FLOW METER
LEMON GLYCERIN SWABS 3.00 PEAK FLOW METER - ADULT
LIGA CLIPS (10 PACK) 70.00 PEAK FLOW METER - PEDI
LINEN CHANGE (EXTRA) 15.00 PEANUT SPOUNGES (TONSIL)
LINEN CHANGE COMPLETE 17.00 PED I BAG
LINEN PAD 5.00 PEDIALYTE (PER BOTTLE)
LINEN SAVER 2.00 PELVIC BELT
LINEN SAVER/DOZ. 14.00 PELVIC EXAM TRAY
LITHOTOMY SHEET 54.00 PELVIC TRACTION BELT
LONG ARM CAST 45.00 PENROSE DRAIN
LONG LEG CAST 55.00 PEROXIDE
LUMBAR TRAY/ADULT 52.00 PHEU EVAC
LUMBAR TRAY/PEDIATRIC 65.00 PHILADELPHIA COLLAR
MAJOR INSTRUMENT POCK 30.00 PILLOW (DISPOSABLE)
MALE URINAL AUTOCLAVABLE 13.00 PILLOW/STAPH CHECK
MANUAL RESUSCITATOR 126.00 PLASTER 4" . ROLL
MASK (O.R.) 3.00 PLATELETS
MEDICINE BOTTLE 1.00 POSTERIOR SPLINT F/LEG
MEMBRANE HOOKS 8.00 POSTERIOR SPLINT S/LEG
MESH HERNIA PATCH 375.00 PULMON AIRE MACHINE
MESH VEST (POSEY) 44.00 PULSE OXIMETER CONTINUOUS
METEROSET (VOLUTROL) 24.00 PULSE OXIMTER SINGLE
MINOR INSTRUMENT PACK 20.00 Q TIPS (STERILE)
N- TERFACE DRESSING 4 X 12 5.00 RAYTEX SPONGE 4X4 (10 PK)
NASAL PACKING 20.00 RAZOR (DISPOSABLE)
NASAL TRAY 22.00 RECTAL TUBE
NEBULIZER (HHN SUPPLIES) 12.00 RESTRAINTS (POSEY VEST)
NEBULIZER (HHN TREATMENT) 20.00 RIB BELT MALE OR FEMALE
3.00 SACROLUMBAR SUPPORT(UNIV) 70.00
7.00 SALEM SUMP TUBE 29.00
3.00 SCALP VEIN 10.00
13.00 SCOTCHCAST SPLINT 35.00
15.00 SHAVING CREAM 4.00
20.00 SHEET 2.00
11.00 SHOE COVERS (PAIR) 3.00
12.00 SHORT ARM CAST 35.00
12.00 SHORT LEG CAST 42.00
12.00 SILVER NITRATE STICK 3.00
8.00 SITZ BATH 12.00
34.00 SKIN CLIPS (6 PK) 10.00
80.00 SLIPPERS 3.00
9.00 SOAP DISH (AUTOCLAVABLE) 2.00
16.00 SPECIMEN CUP 4.00
25.00 SPINAL NEEDLE 8.00
60.00 SPINAL TRAY 102.00
100.00 SPIROMETRY SET UP 26.00
7.00 SPIROMETRY TREATMENT 15.00
70.00 SPLINT ALUMINUM FINGER 10.00
80.00 SPLINT FULL ARM 40.00
50.00 SPLINT OR IV ARM BOARD 15.00
50.00 SPLINT SHORT ARM 25.00
16.00 SPLINT SHOULDER IMMOBILIZ 72.00
6.00 SPLINT UNIV ARM/PAD 35.00
2.00 SPLINT UNIV WRIST TRIM FI 51.00
61.00 SPLINT UNIVERSAL WRIST 57.00
75.00 STERI-STRIPS (BUTTERFLY) 7.00
61.00 STERILE DRESSING (LIGHT) 6.00
9.00 STERILE EXAM GLOVE (EACH) 5.00
5.00 STERILE WATER IRRIGATION 15.00
290.00 STOCKENETTE 10.00
72.00 STOMACH TUBING (LEVINE) 20.00
17.00 STRETCH STERILE BANDAGES 10.00
38.00 SUB-Q SET 15.00
10.00 SUBCLAVIAN CATHETER 265.00
63.00 SUCTION (DEELEE) 11.00
47.00 SUCTION CATHETER 9.00
32.00 SUCTION MACHINE (MINIMAL) 14.00
30.00 SUCTION TIP (METAL/STERIL 7.00
61.00 SUCTION TIP ABDOMINAL 9.00
32.00 SUCTION TONSIL (YANKHAUR) 9.00
3.00 SUCTION TUBING 8.00
20.00 SUPER SPONGES (2 PER PACK 3.00
6.00 SURESITE WINDOW 2X2 4.00
19.00 SURESITE WINDOW 4X4 3.00
33.00 SURGICAL GLOVES PER PAIR 6.00
33.00 SURGICAL GOWN 15.00
SURGICAL PACK - LARGE 100.00
SURGICAL PACK - SMALL 50.00
SUTURE REMOVAL KIT 17.00
SUTURE TRAY 17.00
SUTURES & SURGICAL NEEDLE 20.00
SUTURES (PER PACK) 25.00
SYRINGE 4.00
SYRINGE (BULB) 7.00
SYRINGE 60 CC 6.00
SYRINGE AND NEEDLE (TB) 15.00
SYRINGE AND NEEDLE 3cc 15.00
TEGADERM 8.00
TEGADERM TRANS. DRESSING 6.00
TELFA (ALL SIZES) 4.00
TENDER WET DRESSING 12.00
TENS PADS 30.00
THERMOPHORE 55.00
THORESENTESIS TRAY 102.00
TONSIL SPONGE 16.00
TOOTHBRUSH 2.00
TOOTHPASTE 3 OZ. 2.00
TOOTHPASTE 6 OZ. 4.00
TOURNIQUET CUFF 33.00
TOWELS (STERILE 4 PK) 13.00
TOWELS (STERILE 6 PK) 18.00
TRACTION DAILY CHARGE 14.00
TRACTION SET UP (ANY TYPE 24.00
TRIANGLAR BANDAGE 14.00
TUMBLER (AUTOCLAVE) 2.00
TUMBLER TRAY (AUTOCLAVE) 4.00
U/A HAT - I & 0 HAT 7.00
UA STRAINER 3.00
UNNA BOOT 55.00
URETHRIEAL TRAY (STRAIGHT 22.00
URINAL 5.00
URINARY LEG BAG 10.00
UROSTOMY POUCH 12.00
UROSTOMY WAFER 15.00
VAGINAL PACKING 18.00
VASALINE GAUZE POCKING 20.00
VI DRAPE 33.00
VOLUTROL (METERISET) 24.00
WASH BASIN (AUTOCLAVE) 10.00
WATER PIC (FOR IRRIGATION 7.00
WATER PITCHER (AUTOCLAVE) 8.00
WATERBED MATTRESS 75.00
WHOLE BLOOD 110.00